Surgical Oncology and Regulation of Organ Function, Miyazaki University, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
J Hepatobiliary Pancreat Sci. 2012 Jul;19(4):487-91. doi: 10.1007/s00534-011-0464-8.
This study aimed to verify diagnostic criteria and severity assessment of the Tokyo Guidelines for acute cholangitis.
We re-examined whether acute cholangitis was concomitant with gallstones according to the Tokyo Guidelines in 248 patients with choledocholithiasis. Our conventional diagnoses based on physician decision were compared with diagnoses from the Tokyo Guidelines. Problems with severity grade criteria were also evaluated.
In total, 53 cases of acute cholangitis were determined by using the Tokyo Guidelines, including three false-negative and seven false-positive cases (acute cholecystitis or pancreatitis was concomitant with choledocholithiasis). Sensitivity, specificity, and accuracy were 94%, 96%, and 96%, respectively. Forty of the 53 patients underwent biliary drainage (mean interval between admission and drainage, 1.4 days). Severity grades were mild in 10, moderate in 30, and severe in 13 patients. Of these 13 patients with severe disease, 2 had chronic renal failure, 1 had liver cirrhosis, and 1 had severe acute pancreatitis and liver cirrhosis. No patients died, irrespective of severity grade.
Acute cholangitis should be carefully diagnosed when other inflammatory disease is concomitant with choledocholithiasis. A few patients have absolute acute cholangitis even when they do not meet Tokyo Guidelines diagnostic criteria. Classification into mild or moderate grade using the Tokyo Guidelines is difficult when early biliary drainage is routinely performed. When determining severity grade, clinicians must distinguish between organ dysfunction associated with cholangitis itself and that associated with the underlying/concomitant disease. Apart from a few problems like these, the Tokyo Guidelines are mostly acceptable for the diagnosis and management of acute cholangitis.
本研究旨在验证东京指南对急性胆管炎的诊断标准和严重程度评估。
我们重新检查了 248 例胆管结石患者是否根据东京指南同时伴有胆石症。我们将基于医生决策的常规诊断与东京指南的诊断进行比较，并评估严重程度分级标准存在的问题。
共使用东京指南诊断出 53 例急性胆管炎，其中 3 例为假阴性，7 例为假阳性（急性胆囊炎或胰腺炎同时伴有胆管结石）。敏感性、特异性和准确性分别为 94%、96%和 96%。53 例患者中有 40 例行胆道引流（入院至引流的平均间隔为 1.4 天）。严重程度分级轻度 10 例，中度 30 例，重度 13 例。在这 13 例严重疾病患者中，2 例患有慢性肾衰竭，1 例患有肝硬化，1 例患有严重急性胰腺炎和肝硬化。无论严重程度分级如何，均无患者死亡。
当其他炎症性疾病与胆管结石并存时，应仔细诊断急性胆管炎。即使不符合东京指南的诊断标准，仍有少数患者患有绝对的急性胆管炎。当常规进行早期胆道引流时，使用东京指南将其分类为轻度或中度难度较大。在确定严重程度分级时，临床医生必须区分与胆管炎本身相关的器官功能障碍和与潜在/并发疾病相关的器官功能障碍。除了少数这样的问题外，东京指南大多可接受用于急性胆管炎的诊断和治疗。
