急性化脓性胆管炎：一种新亚型急性胆管炎的临床特征。

Acute suppurative terminal cholangitis: Clinical characteristics of a new subtype of acute cholangitis.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China.

Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2024 Jun;23(3):293-299. doi: 10.1016/j.hbpd.2023.01.001. Epub 2023 Jan 18.

DOI:10.1016/j.hbpd.2023.01.001

PMID:36690523

Abstract

BACKGROUND

Acute suppurative terminal cholangitis (ASTC) is rarer than acute obstructive cholangitis and is not well studied. To explore this subtype of acute cholangitis, we described our clinical experience with ASTC.

METHODS

We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020. We analyzed their clinical characteristics, including etiology, clinical manifestations, imaging features, treatment and prognosis.

RESULTS

A total of 32 ASTC patients were included in the analysis. The majority of the patients had a history of biliary operations, and clinical manifestations were occult and atypical. The positive rate of bacterial culture was 46.9%. All the patients had typical imaging features on computed tomography and magnetic resonance imaging. Treatment with effective antibiotics was provided as soon as diagnosis was established. After treatment, most patients had a good outcome. Elevated levels of total bilirubin, aspartate aminotransferase, procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.

CONCLUSIONS

Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis, and that earlier diagnosis and more personalized treatments are needed.

摘要

背景

急性化脓性胆管炎（ASTC）比急性梗阻性胆管炎少见，研究也较少。为了探讨这种急性胆管炎的亚型，我们描述了我们对 ASTC 患者的临床经验。

方法

我们对 2014 年 9 月至 2020 年 8 月在我院住院的 ASTC 患者进行了回顾性分析。分析了他们的临床特征，包括病因、临床表现、影像学特征、治疗和预后。

结果

共纳入 32 例 ASTC 患者。大多数患者有胆道手术史，临床表现隐匿且不典型。细菌培养阳性率为 46.9%。所有患者的 CT 和 MRI 均有典型的影像学特征。一旦确诊，即给予有效的抗生素治疗。治疗后，大多数患者预后良好。总胆红素、天门冬氨酸氨基转移酶、降钙素原和γ-谷氨酰转移酶升高是重症患者的特征，与预后较差相关。