Lum Donald F., Leung Joseph W.
Division of Gastroenterology, University of California, Davis Health Care System, 4150 V Street, Suite 3500, Sacramento, CA 95817, USA.
Curr Treat Options Gastroenterol. 2001 Apr;4(2):139-146. doi: 10.1007/s11938-001-0026-2.
The treatment of acute bacterial cholangitis requires broad-spectrum antibiotics to cover against gram-negative aerobic enteric organisms (Escherichia coli, Klebsiella species, and Enterobacter species), gram-positive Enterococcus and anaerobic bacteria (Bacteroides fragilis and Clostridium perfringens). Approximately 20% of patients with acute cholangitis fail to respond to conservative treatment with antibiotic therapy and require urgent biliary decompression, which is the mainstay of therapy. This is best accomplished by endoscopic retrograde cholangiopancreatography (ERCP) and placement of a nasobiliary drainage tube or a large bore (10 F or larger) indwelling plastic stent. Alternative therapy includes percutaneous transhepatic biliary drainage or surgical biliary decompression, but these carry a significantly higher morbidity and mortality. Supportive care includes intravenous fluid hydration to prevent renal failure and close monitoring of vital signs for determination of potential septicemia.
急性细菌性胆管炎的治疗需要使用广谱抗生素，以覆盖革兰氏阴性需氧肠道菌（大肠杆菌、克雷伯菌属和肠杆菌属）、革兰氏阳性肠球菌和厌氧菌（脆弱拟杆菌和产气荚膜梭菌）。约20%的急性胆管炎患者对抗生素保守治疗无反应，需要紧急胆道减压，这是治疗的主要手段。通过内镜逆行胰胆管造影术（ERCP）并放置鼻胆管引流管或大口径（10F或更大）留置塑料支架可最佳地实现这一点。替代疗法包括经皮经肝胆管引流或外科胆道减压，但这些疗法的发病率和死亡率显著更高。支持性治疗包括静脉补液以预防肾衰竭，并密切监测生命体征以确定是否存在潜在败血症。
