Clinical Research Of Choice In Treatment Of Acute Obstructive Suppurative Cholangitis

Objective:Comparing bile duct decompression, T tube drainage surgery; ERCP+EST+ENBD surgery; PTCD surgery in the treatment of patients with acute obstructive suppurative cholangitis (AOSC) in order to the provide the basis with clinical treatment of AOSC surgery Options.Material and methods:The subject collection of Kunming Medical University Second Affiliated Hospital of Hepatobiliary second surgery ward in January2012to December2012twelve months56cases of acute obstructive suppurative cholangitis patients. Including:biliary decompression. T tube drainage surgery in21patients (group A);2. the ERCP+EST+ENBD surgery by13patients (group B); PTCD surgery in22patients (group C). Preoperative and postoperative antibiotics two together control the infection. Analysis of each operative patients before24hours. after24hours.72hours,1week,2weeks and discharge, total bilirubin, alanine aminotransferase,septic shock, nervous system by inhibition of symptoms.complication rates, death rate, number of days of hospitalization compare. Application SPSS17.0software, data using measurement data in each group were compared using the t test, P<0.05was considered statistically significant.Results:1.within72h after surgery, biliary decompression, T tube drainage surgery group (group A) total bilirubin, alanine aminotransferase (ALT) decline was better than ERCP+EST+ENBD surgery group (B group).but after1week showed no difference; postoperative after24h, group A’s septic shock and nervous system by inhibiting symptom relief significantly compared with group B group, but the postoperative after 72h. both of them showed no difference; A group4deaths; A group’s morbidity and mortality was significantly higher than that in group B; A group’s hospital stay’s days was significantly shorter than in group B.2after1week, biliary decompression, T tube drainage surgery group (group A) total bilirubin, alanine aminotransferase (ALT) decreased effect was better than PTCD surgery group (group C).but after two weeks showed no difference; postoperative after24h,group A’s septic shock and nervous system by inhibiting relieve symptoms relief more obvious than in group C, but the postoperative after72h, both of them showed no difference; A group’s complications and mortality was significantly higher than in group C; A group’s hospital stay’s days was significantly shorter than the C group.3.ERCP+EST+ENBD surgery group (group B) and PTCD group (group C) compared decline in total bilirubin. alanine aminotransferase decreased, septic shock and nervous system by inhibiting the symptoms remission had no statistical significance; postoperative complications, mortality was not statistically significant:B group’s hospitalization days shorter than the C group.conclusion:1.PTCD surgery can fully drain bile and relieve biliary pressure.result of relieving biliary obstruction was satisfactory. And this surgery is minimally invasive, relatively simple, shorter operative time, without general anesthesia, postoperative complications, lower mortality and so on. It suit for damage control surgery (DCS) principle. It ease AOSC patient crisis symptoms,and create the conditions for the cause of the secondary radical surgery. PTCD surgery suit for disease:intrahepatic and extrahepatic bile duct dilatation caused by stones and the AOSC patients.2. ERCP+EST+ENBD AOSC surgery can relieve some of the patient’s common bile duct obstruction, get adequate drainage of bile.and reduce bile duct stress, and relieve symptoms of AOSC critical patients. It can get Surgical trauma and faster postoperative recovery.It suit for disease:bile duct obstruction caused by stones AOSC patients. Contraindications:Patients older, septic shock and severe psychiatric symptoms, heart, brain, blood vessels, lungs and other concurrent diseases.3. Biliary decompression, T tube drainage surgery can also get adequate drainage of bile, bile duct pressure lifted immediately, which can also be found under direct vision and relieve some cause of obstruction. But it get surgical trauma, the formation of two-hit, and the anesthesia breathing, blood circulation affecting mortality and causes the highest incidence of postoperative complications. For disease:Unable OK ERCP+EST+ENBD treatment, PTCD puncture failure of AOSC surgery patients. Contraindications:Patients older, septic shock and severe psychiatric symptoms, heart, brain, blood vessels, lungs and other concurrent diseases.