Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines.
Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines.
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DOI：
10.1007/s00534-006-1153-x
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Dervenis, Christos
中科院分区：
文献类型：
--
作者：
Miura, Fumihiko;Takada, Tadahiro;Kawarada, Yoshifumi;Nimura, Yuji;Wada, Keita;Hirota, Masahiko;Nagino, Masato;Tsuyuguchi, Toshio;Mayumi, Toshihiko;Yoshida, Masahiro;Strasberg, Steven M.;Pitt, Henry A.;Belghiti, Jacques;de Santibanes, Eduardo;Gadacz, Thomas R.;Gouma, Dirk J.;Fan, Sheung-Tat;Chen, Miin-Fu;Padbury, Robert T.;Bornman, Philippus C.;Kim, Sun-Whe;Liau, Kui-Hin;Belli, Giulio;Dervenis, Christos
关键词：
根据严重程度分级，急性胆道炎症/感染（急性胆管炎和急性胆囊炎）的诊断和治疗策略在世界上尚未确立。因此，我们根据严重程度制定了急性胆道炎症/感染管理的流程图。对于轻度（I级）急性胆管炎，药物治疗可能足够/适当。对于中度（II级）急性胆管炎，应进行早期胆道引流。对于重度（III级）急性胆管炎，需要适当的器官支持，如辅助/循环管理。血流动力学稳定后，应立即行内镜或经皮经皮胆道引流术。对于任何严重程度的急性胆管炎患者，应在患者的一般状况改善后进行潜在病因的治疗，包括内镜、经皮或手术治疗。对于轻度（I级）胆囊炎患者，早期腹腔镜胆囊切除术是首选治疗方法。对于中度（II级）急性胆囊炎患者，首选早期腹腔镜或开腹胆囊切除术。在广泛的局部炎症患者中，建议在经皮胆囊引流和/或胆囊造口术的初始管理后进行择期胆囊切除术。对于严重（III级）急性胆囊炎患者，多器官支持是管理的关键部分。胆囊穿孔引起的胆汁性腹膜炎是紧急胆囊切除术和/或引流的指征。延迟择期胆囊切除术可在胆囊引流初步治疗和患者一般医疗状况改善后进行。
Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient’s general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient’s general medical condition.
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