术后急性非结石性胆囊炎12例分析

对我院1997—12～2004—06手术后急性非结石性胆囊炎12例分析如下。     

急性非结石性胆囊炎的腹腔镜治疗

目的 探讨急性非结石性胆囊炎病人行腹腔镜胆囊切除术（LC）治疗的经验。方法 回顾性分析了该院1999年6月。2006年5月956例急性胆囊炎病例的临床资料。结果 956例病人中，共有36例急性非结石性胆囊炎病人,所有36例病人皆接受LC治疗，其中胆囊部分切除7例（19．4％），中转开腹4例（11．1％），手术时间89。257min。均痊愈出院，无术中和术后并发症。结论 腹腔镜胆囊切除或部分切除可以作为急性非结石性胆囊炎病人的首选手术方式。     

老年急性非结石性胆囊炎25例外科治疗分析

目的：探讨老年人急性非结石性胆囊炎的病因、诊断与治疗。方法：回顾分析25例老年人急性非结石性胆囊炎临床资料。结果：24例手术治疗，其中胆囊切除18例。胆囊造瘘4例，胆囊切除、胆道探查、T管引流2例；保守治疗1例。全组死亡1例。结论：老年人急性非结石性胆囊炎是临床上的罕见病，胆囊病变重，并存疾病多，B超和CT可以作为疾病诊断的首选检查，症状出现48h内确诊并积极手术治疗是提高治愈率，降低病死率的关键；     

腹部手术后急性非结石性胆囊炎18例分析

目的 探讨中手术后急性非结石性胆囊炎的相关问题。方法 回顾性分析18例资料较全的腹部手术后急性非结石性胆囊炎病例。结果 9例术中出现一过性低血压，5例术后出现一过性低血压，8例在急性非结石性胆囊炎基础上出现多器官功能衰竭。14例行手术治疗，死亡2例；4例行保守治疗，死亡2例。结论 腹部手术后发生急性非结石性胆囊炎是多因素的结果，但与胆囊缺血即胆囊低灌注关系密切。急性非结石性胆囊炎可诱发多器官功能衰竭。     

急性非结石性胆囊炎病因及外科治疗

手术治疗急性非结石性胆囊炎（ＡＡＣ）３５例，并结合文献对ＡＡＣ的病因及外科治疗进行了分析探讨，指出ＡＡＣ主要是由于胆道异常、胆囊缺血、胆囊排空障碍和细菌感染等引起，及时行胆囊切除术是治疗ＡＡＣ的主要手段。     

腹腔镜治疗老年性急性非结石性胆囊炎16例临床报道

目的 探讨腹腔镜对老年性急性非结石性胆囊炎行胆囊切除术的安全性.方法 对湖南省娄底市涟钢医院2002～2004年底所收治的16例老年急性非结石性胆囊炎患者行腹腔镜胆囊手术.结果 均顺利完成腹腔镜胆囊术.全组无死亡,无胆道损伤、出血等并发症.结论 随着腹腔镜胆囊切除术经验积累,老年性急性非结石性胆囊炎可安全地完成腹腔镜胆囊手术.     

非结石性急性胆囊炎一例误诊分析

【病例】　男,64岁。因左上腹间歇性疼痛2年余,加重呈刀割样疼痛13小时入院。2年前感左上腹部疼痛就诊,行胃镜检查提示为“胃溃疡”,给予药物对症治疗,症状缓解。此后腹痛时有发生,每次都自服胃药后好转。于入院前日下午4时突发上腹部刀割样疼痛,急送当地卫生所,经抗感染等治疗     

急性非结石性胆囊炎的诊治分析

目的:探讨急性非结石性胆囊炎的临床诊断和治疗的方法。方法:对28例急性非结石性胆囊炎的术前资料、手术时机、治疗方法和并发症进行回顾分析。在发病48h内手术方式以胆囊切除为主,发病48h后手术方式以胆囊大部切除术和加胆囊造口术为主。结果:28例患者中,大于60岁者20例(71.4%),其中有合并症22例次(78.6%),发生于大手术和严重创伤后共21例(75.0%)。在发病48h内手术者,胆囊病变以化脓多见,而发病48h后手术者,胆囊病变主要为坏疽与穿孔;在发病48h内手术方式以胆囊切除为主,发病48h后手术方式以胆囊大部切除术和胆囊造口术为主;发病48h内手术的并发症与死亡率均较48h后手术者低。结论:急性非结石性胆囊炎常见于老年人,合并症多,常发生于大手术和严重创伤后,宜在发病48h内尽早手术。     

急性非结石性胆囊炎的诊断和治疗

急性非结石性胆囊炎（acuteac alculous cholecystitis,AAC）是指影像学检查、手术和病理学检查均未发现胆囊结石的胆囊急性炎症病变,其病因复杂、起病急骤、病情进展快、易发生胆囊坏疽及穿孔等严重并发症、死亡率高,因而被认为是一种与急性结石性胆囊炎截然不同的、相对独立的临床疾病。     

腹腔镜手术治疗急性非结石性胆囊炎37例临床分析

目的探讨腹腔镜在急性非结石性胆囊炎手术中的应用价值。方法回顾性分析本院7年间腹腔镜下手术治疗急性非结石性胆囊炎37例的临床资料。结果37例急性非结石性胆囊炎患者经腹腔镜手术（其中5例中转开腹手术），均治愈出院。结论急性非结石性胆囊炎患者行腹腔镜手术疗效可靠，且腹腔镜手术创伤小、痛苦少、恢复快，有明显的优越性。     

Acute acalculous cholecystitis in acute renal failure

Acute acalculous cholecystitis developed in 16 of 92 patients with acute renal failure who had no prior or coincidental biliary tract disease. The cause of this complication is considered to be multifactorial. Risk factors include sepsis, previous surgery, trauma, total parential nutrition, intermittent positive pressure ventilation, opiate sedation, multiple transfusions and hypotension. One patient had 5 risk factors, 15 had 6 or more. Diagnosis was based on clinical suspicion, serial ultrasound scanning and serial estimations of white cell count, liver function and C-reactive protein. Four patients were treated conservatively with antibiotics and ultrasound observation, 10 underwent cholecystotomy and 2 patients had cholecystectomy. Eleven patients survived (69% survival). No patient treated by cholecystotomy required further surgery to the biliary tract. Acute acalculous cholecystitis has become a significant complication in our “high risk” acute renal failure population as intensive care has advanced and patients are surviving longer. Prompt and appropriate treatment will prevent it contributing significantly to the already high mortality of acute renal failure. Anticipation is the watchword.     

急性非结石性胆囊炎的诊断与治疗

目的 探讨急性非结石性胆囊炎的诊断及治疗方法。方法 结合国内外相关文献，对近年来本院收住的41例急性非结石性胆囊炎患者临床资料进行回顾性分析。结果 41例急性非结石性胆囊炎患者经过个性化治疗后，39例治愈，2例死亡。结论 急性非结石性胆囊炎是一种相对独立的临床疾病，其重症患者并发症率和病死率高，早期诊断及个性化治疗是提高疗效的关键，对于不能耐受手术的患者，B超引导下经皮胆囊穿刺造瘘，是一种有效、安全可靠、操作简便且花费较少的治疗手段。     

超声在老年急性非结石性胆囊炎诊断中的应用

目的 探讨超声在老年急性非结石性胆囊炎诊断中的价值。 方法回顾性总结和分析29例老年人急性非结石性胆囊炎。结果超声对急性非结石性胆囊炎的显示率和诊断符合率均为100％。急性非结石性胆囊炎的胆囊长径、宽径明显大于对照组(P<0.01),其胆囊壁较对照组增厚(P<0.01)。 结论 超声对急性非结石性胆囊炎具有重要的诊断价值。     

Computed tomography as an adjunct to ultrasound in the diagnosis of acute acalculous cholecystitis

The sonographic and computed tomographic (CT) findings were reviewed in 17 patients with acute acalculous cholecystitis (AAC) over a 6-year period from 1984 to 1989. Of the six patients in whom both ultrasound and CT were performed, CT revealed marked gallbladder (GB) wall abnormalities, including perforation, and pericholecystic fluid collections in five patients not demonstrated by sonography. Of the total group, five patients had GB wall thicknesses of 3 mm (normal) at pathologic examination, which demonstrated a spectrum of disease ranging from acute hemorrhagic/necrotizing, to gangrenous acalculous cholecystitis with perforation. Sonography was falsely negative or significantly underestimated the severity of AAC in seven of the 13 patients examined by sonography. CT because of its superior ability to assess pericholecystic inflammation may provide additional diagnostic information even after a thorough sonographic study in cases of AAC.     

腹腔镜胃肠术后急性非结石性胆囊炎的临床分析

目的 为探讨腹腔镜胃肠手术后发生急性非结石性胆囊炎的诊断及治疗.方法 回顾性分析2003年1月～2008年12月在该院行腹腔镜胃肠手术、术后发生急性非结石性胆囊炎的10例患者的诊治过程.结果 6例患者行开腹胆囊切除,1例患者行开腹胆囊次全切除,另有3例患者再次行腹腔镜下胆囊切除术,术后无胆管相关并发症发生,均治愈出院.结论 腹腔镜下胃肠道大手术后少数患者易发生急性非结石性胆囊炎.其原因复杂.临床需早期诊断,治疗方法一般选择胆囊切除术,具体术式应当遵循个体化原则.     

Postoperative acute acalculous cholecystitis — An assessment of diagnostic procedures

Two cases with postoperative acute acalculous cholecystitis diagnosed by computed tomography (CT) and ultrasonography are described. This rare postoperative complication is briefly reviewed. The mortality from this complication is high because the diagnosis is often missed. Use of diagnostic tools such as ultrasonography and CT increases the possibilities of reaching a correct diagnosis and therefore improves the prognosis.     

老年胆石症伴急性胆囊炎保守与手术治疗的选择

目的探讨老年胆石症伴急性胆囊炎保守与手术治疗的选择。方法选择胆石症伴急性胆囊炎的老年患者170例为研究对象,手术治疗的患者纳入研究组(n=92),保守治疗的患者纳入对照组(n=78),比较两组临床症状完全缓解时间、住院时间、进食时间与肠功能恢复时间等治疗结果。结果术中发现胆囊结石共92例(100%),胆囊积脓26例(28.26%),胆囊坏疽11例(11.96%),胆汁性腹膜炎共6例(6.52%),并发胆总管结石共12例(13.04%)。研究组临床症状完全缓解时间、住院时间显著小于对照组,其余无显著差异。手术组患者均成功治疗,手术后并发上呼吸道感染6例,肺炎2例,心功能不全1例,无临床死亡。结论早诊断、早治疗,严格掌握手术适应证,在围手术期对基础疾病恰当处理,这些是老年急性胆囊炎伴胆石症治疗成功的关键。     

Clinical characteristics of patients with newly developed acute cholecystitis after admission to the intensive care unit

IntroductionCritical care patients have many risk factors for acute cholecystitis (AC). However, less data are available regarding newly developed AC in critically ill patients.ObjectivesTo investigate the clinical features of AC occurring in critically ill patients after admission to an intensive care unit (ICU).MethodsWe performed a retrospective cohort study from January 2006 to August 2016 at a tertiary care university hospital. We included patients diagnosed with AC with or without gallstones after ICU admission. All cases of AC were confirmed by gastroenterologists or general surgeons. We excluded patients with AC diagnosed before or at the time of ICU admission.ResultsA total of 38 patients were diagnosed with AC after ICU admission between January 2006 and August 2016. Seventeen (44.7%) had acute acalculous cholecystitis, while 21 (55.3%) had acute calculous cholecystitis. The median age was 73 years (interquartile range = 63–81 years), and 22 (57.9%) patients were male. The most common reason for ICU admission was pneumonia or sepsis. The median interval from ICU admission to diagnosis of AC was 11 days (interquartile range = 4.8–22.8 days). Before AC diagnosis, almost 90% of patients used total parenteral nutrition, 68% used opioids, 76% were mechanically ventilated, and 42% received vasoactive drugs. More than half of patients underwent cholecystectomy, and all surgically resected gallbladders had pathology results for cholecystitis. Gangrenous cholecystitis was observed in five patients with acute calculous cholecystitis. The overall mortality was 42.1%, and 1/3 of these deaths were directly associated with AC. The average length of stay in the ICU and hospital was 26.5 and 44.5 days, respectively.ConclusionThe development of AC in the ICU should be carefully monitored, especially in patients who have been infected and admitted to the ICU for more than 10 days. Proper diagnosis and treatment at a critical time could be lifesaving.     

Acute acalculous cholecystitis and cardiovascular disease: a land of confusion

Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.     

Ultrasonographic findings in acute acalculous cholecystitis

Acute acalculous cholecystitis (AAC) is usually seen as a complication of major surgery or trauma. Although this entity is well-known in the surgical literature, little has been written about it in the radiologic literature. A review of patient records from 1975 through 1982 revealed 16 patients with pathologically confirmed AAC on whom at least 1 sonographic study had been performed. Thickening of the gallbladder wall, a subserosal halo of edema, pericholecystic abscess, and marked gallbladder distention were consistent findings in AAC. In the proper clinical setting, these otherwise nonspecific findings allow a prompt and accurate diagnosis.