Clinical manifestation and management of acute cholangitis severe type with different types of obstruction / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical manifestation and management of acute cholangitis severe type (ACST) with different typos of obstruction. Methods From January 1997 to December 2006, 164 consecutive patients with ACST had been admitted to Chengdu First People's Hospital. All patients were divided into extrahepatic type group (n=122), intrahepatic type group (n=18) and mixed type group (n=24) accord-ing to the types of obstruction. Clinical manifestation and therapeutic outcome of the 3 groups were analyzed using chi-square test, continuity correction test or Fisher exact test. Results There was no significant difference in clinical manifestation between patients with extrahepatic type and those with mixed type (P>0.05). The incidence of jaundice and abdominal pain in patients with intrahepatic type is significantly lower than those with extrahepatic type (P<0.05). The incidences of distention in consciousness and response to initial medical treat-ment were higher than those with extrahepatic type (P<0.05). The total mortality rate was 9.8% (16/164). Of all patients, 123 received open surgery. There was no significant difference in morbidity and mortality in patients with intrahepatic type and mixed type (χ~2=0.172,0.789; 1.769, 1.948, P>0.05). In emergency operation, the incidence of biliary high pressure and postoperative vital sign improvement rates were significant higher in patients with extrahepatic type than the other 2 types (P<0.05). The morbidity and mortality of patients who received emergency operation were higher than non-emergency operation (P<0.05). Conclusions The clinical manifestation of ACST is different between intrahepatic obstructive type and the other 2 types. There is no signi-ficant difference in morbidity and mortality among the 3 types of obstruction. The morbidity and mortality are high in patients who received emergency operation. Proper management of surgical timing is helpful in decreasing the morbidity and motality of ACST.