冬季海南"候鸟人群"急性胆囊炎临床特点分析

目的探讨海南冬季"候鸟人群"急性胆囊炎发作的临床特点。方法回顾性分析2017年至2019年3个冬季(11月~次年2月)在解放军总医院海南医院因急性胆囊炎入院治疗的患者资料。依据确诊时抵达海南的时间分为短期组(<30 d)、中期组(30~89 d)和长期组(>90 d),比较三组患者的一般资料、合并疾病情况、胆囊炎临床特点等,并进一步分析短期组化脓性胆囊炎和非化脓性胆囊炎患者临床特征。结果共纳入120例患者,其中短期组49例,男性29例,女性20例,年龄(65.18±15.02)岁;中期组24例,男性13例,女性11例,年龄(66.21±11.93)岁;长期组48例,男性30例,女性18例,年龄(60.73±12.54)岁。三组患者的年龄、性别、体质量指数、吸烟史及饮酒史情况的组间差异均无统计学意义(P>0.05)。三组患者治疗方式及转归情况差异均无统计学意义(P>0.05)。与长期组患者相比,短期组患者合并高血压20.83%(10/48)比48.98%(24/49)]和糖尿病10.42%(5/48)比30.61%(15/49)]比例较高,短期组的胆囊壁厚度较长期组厚0.60(0.40,0.70)cm比0.50(0.30,0.60)cm],差异具有统计学意义(P<0.017)。短期组急性胆囊炎患者中化脓性胆囊炎比例高于长期组48.15%(13/27)比17.24%(5/29)],差异具有统计学意义(P<0.017)。短期组中化脓性胆囊炎的泥沙样结石38.46%(5/13)比14.29%(2/14)]、胆囊穿孔30.77%(4/13)比0]、胆囊坏疽53.85%(7/13)比7.14%(1/14)]、胆囊周围积液76.92%(10/13)比14.29%(2/14)]、腹腔积液46.15%(6/13)比7.14%(1/14)]比例高于非化脓性胆囊炎患者,差异均具有统计学意义(P<0.05)。结论"候鸟人群"抵达海南短期内发作急性胆囊炎者炎症重,易合并化脓、穿孔、坏疽等,合并高血压病和糖尿病者可能是"候鸟人群"抵达海南后短期内发作急性胆囊炎的高危人群。

Clinical features of"migration birds"population in Hainan Province in winter presenting with acute cholecystitis

Objective To study the clinical features of the"migration birds"population in Hainan Province in winter presenting with acute cholecystitis.Methods Patients who were diagnosed to suffer from acute cholecystitis in the winter months from November to February of the following year of 2017,2018 and 2019 and admitted in Hainan Hospital of Chinese PLA General Hospital were included in this study.The"migration birds"patients who arrived in Hainan Province in less than 30 days were defined as the short-term group(n=49),30-89 days as the mid-term group(n=24),more than 90 days as the long-term group(n=48).The general information,associated medical diseases,clinical presentations,interventional strategies and in-hospital outcomes were compared,and further analyze the clinical characteristics of patients with purulent cholecystitis and non-purulent cholecystitis in the short-term group.Results Of 120 patients,there were 49 patients in the short-term group(29 males and 20 females with an average age of 65.18±15.02 years),24 patients in the mid-term group(13 males and 11 females with an average age of 66.21±11.93 years),and 48 patients in the long-term group(30 males and 18 females with an average of 60.73±12.54 years).The general information,interventional strategies and in-hospital outcomes were similar among the three groups.When compared with patients in the long-term group,patients in the short-term group had higher incidences of hypertension20.83%(10/48)vs 48.98%(24/49)]and diabetes10.42%(5/48)vs 30.61%(15/49)].The gallbladder wall in the short-term group was significantly thicker than that in the long-term group0.60(0.40,0.70)cm vs 0.50(0.30,0.60)cm,P<0.017].The proportion of purulent cholecystitis in the short-term group was significantly higher than that in the long-term group48.15%(13/27)vs 17.24%(5/29),P<0.017].In the short-term group,the incidences of silt-like stones of purulent cholecystitis38.46%(5/13)vs 14.29%(2/14)],gallbladder perforation30.77%(4/13)vs 0],gallbladder gangrene53.85%(7/13)vs 7.14%(1/14)],perigallbladder effusion76.92%(10/13)vs 14.29%(2/14)],abdominal effusion46.15%(6/13)vs 7.14%(1/14)]were significantly higher than that of patients with non-purulent cholecystitis,(all P<0.05).Conclusion Patients presenting with acute cholecystitis after arrival in Hainan in the short term had more severe inflammation with complications of suppuration,perforation and gangrene.Patients with hypertension and diabetes were the high risk group of patients presenting with acute cholecystitis after short-term arrival in Hainan.