Comparative Outcome Of Laparotomy Versus DCS In Acute Cholangitis Of Severetype(ACST)

Objective:ACST has the acute onset, rapid development, high mortality characteristics. Mostly patients are elderly, accompanied by hypertension, coronary heart disease, diabetes and other medical disorders. It has resulted in complex disease, easily deteriorate rapidly increasing, and even life-threatening. This article comparative studied the clinical effect of differences between Laparotomy treatment (Laparotomy) and damage control surgery(DCS) for the treatment of ACST, in order to prove DCS has the value in the treatment of ACST.Method:Between September 1997 and July 2009,128 cases of ACST diagnosis patients were retrospective analysised, with whom accepted the treatment of Laparotomy or DCS at general surgery department of First Affiliated Hospital of Dalian Medical University. According to the treatment patients were divided into L groups and DCS groups. The L group consisted of 66 patients and the DCS group consisted of 62 patients. Compare the two groups'postoperative mortality, postoperative complica-tion rate, hospital stay and hospital costs and other indicators, and statistically analyzed.Results:L group:Postoperative mortality 18.1%(12/66),six patients died due to multiple organ failure, two cases of infection toxic shock, and death after turning to the ICU,1 case of disseminated intravascular coagulation with severe renal failure,1 case of severe metabolic acidosis combined circulation failure in death,2 cases for the second (or subsequent) died in hospital; Postoperative complications 28.79%(19/66),9 cases of incision infection,3 cases of respiratory failure or pulmonary infection, two cases of acute pancreatitis,1 case of circulation failure,3 cases of septic shock,1 case of DIC with renal failure,1 case of subphrenic abscess with bile leak; Average length of hospitalization 27.53 days; Average hospital expenses￥9600±370; DCS group:Postoperative mortality 6.45%(4/62),1 case of multiple organ failure,1 case of terminal liver disease with bleeding from the upper alimentary tract,2 cases for the second (or subsequent) died in hospital; Postoperative complications 14.52%(9/62),3 cases from PTCD group of hemobilia,2 cases of biliary infections,1 case of liver abscess and 1 case of septic shock; ERCP group 1 case of acute pancreatitis,1 case of hemobilia, Average length of hospitalization 22.16 days; Average hospital expenses￥7800±420; Two groups of patients have no statistically significant in gender, age, preoperative symptoms (P>0.05). Two groups of patients have no statistically significant differences in the postoperative complications, the length of time, hospital expenses (P>0.05). Two groups of patients has statistically significant in postoperative mortality (P<0.05).Conclusions:Laparotomy and DCS are the two ways of the treatment for ACST. Compared with Laparotomy, DCS has significantly lower postoperative mortality in the treatment of ACST. Although there is no significant statistical difference in the incidence of postoperative complica-tions, hospital stay, hospital charges between the DCS group and L group in this study, but the DCS group's comparative advantage in above-mentioned three aspects can still be seen from the statistical data, treatment is certain, worth to be promoted further.