Arima N, Uchiya T, Hishikawa R, Saito M, Matsuo T, Kurisu S, Umeki M, Kita Y, Koyama T, Hatta T
Department of Internal Medicine, Hyogo Prefectural Awaji Hospital.
Nihon Ronen Igakkai Zasshi. 1993 Nov;30(11):964-8. doi: 10.3143/geriatrics.30.964.
Acute cholangitis due to impacted bile duct stone is sometimes fatal and require prompt bile duct decompression. Particularly, AOSC (acute obstructive suppurative cholangitis) is the most serious form of bacterial cholangitis and its prognosis is usually very poor when treated conservatively. We have been treated impacted bile duct stones by decompressing the duct endoscopically. Here, we report the characteristics of our elderly patients with impacted bile duct stones who received urgent decompression treatment mainly by endoscopic techniques. In the endoscopical treatment group, the number of patients with AOSC was 5 out of 46 AC (acute cholangitis) patients (11%) under 69 years old, 14 out of 52 (27%) from 70 to 79 years old, and 12 out of 28 (43%) over 80 years old. Obviously, the severity of acute cholangitis (ratio of AOSC to AC) was higher in the elderly. This tendency was similar to the patients who received urgent transhepatic decompression treatment, although they were small in number. In all the patients treated, 7 were classified into the most serious AOSC category with Reynolds' sign, and notably 6 out of 7 were over 70 years old. More strikingly, 5 of 7 patients were over 80, and their mortality rate was indeed high. Thus, in the elderly, bacterial cholangitis by impacted bile stones was a very serious condition. Especially, the outcome of AOSC over 80 years old with Reynolds' sign was very poor, in spite of emergency endoscopic treatment.
胆管结石嵌顿所致的急性胆管炎有时会致命，需要迅速进行胆管减压。特别是急性梗阻性化脓性胆管炎（AOSC）是细菌性胆管炎最严重的形式，保守治疗时其预后通常很差。我们一直通过内镜下胆管减压来治疗胆管结石嵌顿。在此，我们报告主要采用内镜技术进行紧急减压治疗的老年胆管结石嵌顿患者的特点。在内镜治疗组中，69岁以下的46例急性胆管炎（AC）患者中有5例（11%）发生AOSC，70至79岁的52例中有14例（27%），80岁以上的28例中有12例（43%）。显然，老年人急性胆管炎的严重程度（AOSC与AC的比例）更高。这种趋势与接受紧急经肝减压治疗的患者相似，尽管后者数量较少。在所有接受治疗的患者中，7例被归类为伴有雷诺兹征的最严重AOSC类别，值得注意的是，7例中有6例年龄超过70岁。更惊人的是，7例患者中有5例年龄超过80岁，他们的死亡率确实很高。因此，在老年人中，胆管结石引起的细菌性胆管炎是一种非常严重的疾病。特别是，80岁以上伴有雷诺兹征的AOSC患者，尽管接受了紧急内镜治疗，但其预后仍然很差。
