<原著>胆管結石の予後に関する臨床的研究 : 特に急性閉塞性化膿性胆管炎について
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概要
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We retrospectively studied 172 cases of bile duct stones including 106 cases (61.6%) of acute cholangitis (AC), 27 cases (15.7%) of acute obstructive suppurative cholangitis (AOSC) and 39 cases (22.7%) classified as mild case. Deaths occurred only among the patients with AOSC and the mortality rate of AOSC was 29.6%. There was a difference in mortality rate of AOSC between the emergency drainage set up group (16.7%) and the conservative therapy group (40.0%). Since the introduction of the endoscopic nasobiliary drainage (ENBD) method, the mortality rate of AOSC has improved to 0%. Emergency drainage with ENBD could be introduced easily and safely even though the patient had been complicated by disseminated intravascular coagulation (DIC). Significant increases of serum bilirubin, thrombocytopenias and decreases in antithrombin III (ATIII) activity were observed especially in the deaths from AOSC. Each level of serum bilirubin of more than 10.0mg/dl, platelet counts of less than 3.0×10^4/cmm and levels of ATIII activity less than 40% indicated a poor prognosis. It is noteworthy that fibrinogen levels exhibited a normal or high titer even in patients with DIC. Other factors related to the poor prognosis were male, the seventies, common duct stones, multiple organ failure and DIC. Especially when two or more of these factors were recognized simultaneously, prognosis was still poor. DIC or suspected DIC were observed in 70.8% of the patients with AOSC. It is important to start therapy as soon as possible before DIC becomes irreversible. Since a positive correlation between platelet counts and levels of ATIII activity (r=0.44,n=85,p<0.001) and a negative correlation between levels of fibrinogen degradation products and levels of ATIII activity (r=-0.32,n=70,p<0.001) were observed, the complication of DIC in patients with AOSC was thought to be closely related to the consumption of ATIII. Therefore, the treatment of patients with AOSC needs not only an early drainage set up but also an assay of ATIII in the early stage. When levels of ATIII activity are low, ATIII substitution is recommended.
- 近畿大学の論文
- 1992-09-25
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