急性非结石性胆囊炎21例诊治剖析.docVIP

急性非结石性胆囊炎21例诊治剖析 　　【摘要】 目的 探讨急性非结石性胆囊炎(acute acalculous cholecystitis,AAC)的临床特点与治疗方法。方法 回顾性分析我院2000~2008年收治的21例急性非结石性胆囊炎的临床资料。结果 本组病例占同期急性胆囊炎病例的11.29%(21/186),均并存有不同程度的系统性疾病,心血管病有高血压、冠心病、心律失常42.9%(9/21);肝脏疾病有脂肪肝、慢性肝炎33.3%(7/21);胆道疾病有胆囊息肉、胆道蛔虫14.3%(3/21);糖尿病23.8%(5/21)。两个系统同时有病者3例。18例行早期胆囊切除术,3例作胆囊造瘘术,其中7例胆囊坏死、穿孔(33.3%),均获得痊愈。术后并发症8例包括切口感染、切口裂开、腹腔感染、肺部感染、应激性溃疡等。21例患者无1例死亡。结论 本病进展快,胆囊坏疽、穿孔比例高,术后并发症多,一旦诊断,应积极手术治疗。 　　【关键词】 非结石性胆囊炎;外科治疗 　　 　　Clinical analysis of 21 acute acalculous cholecystitis cases 　　KONG Liang.The Sixth People’s Hospital of Datong,Datong 037000,China 　　【Abstract】 Objective To investigate the clinical features and treatment of the acute acalculous cholecystitis(AAC).Methods The data of 21 clinical acute acalculous cholecystitis cases in our hospital from 2000 to 2008 were analysis retrospectively.Results Over the same period,this group of cases was accounted for 11.29%of all cases of acute cholecystitis(21/186).All 21 cases exist with varying degrees of systemic diseases.The cardiovascular diseases were hypertension,coronary heart disease,arrhythmia 42.9%(9/21).The liver diseases were fatty liver,chronic hepatitis,33.3%(7/21).The biliary tract diseases were gallbladder polyps,biliary ascariasis 14.3%(3/21)and there were diabetes,23.8%(5/21).There were 3 cases effected in two systems at the same time.18 cases underwent early cholecystectomy,cholecystostomy for three cases,including 7 cases of gallbladder necrosis,perforation(33.3%),and both were cured.8 cases of postoperative complications,including wound infection,wound dehiscence,intra-abdominal infections,lung infections,such as stress ulcer.Non patient died.Conclusion AAC progressed rapidly and has a high proportion of postoperative complications such as gallbladder gangrene,perforation.If there has get the confirmed diagnosis,the operation should be actively done. 　　【Key words】 Acalculous cholecystitis; Surgical treatment 　　 　　急性非结石性胆囊炎(acute acalculous cholecystitis,AAC)是指胆囊壁有明显的炎症改变而胆囊