胆囊扭转的诊治

胆囊扭转指由于胆囊系膜过长,胆囊沿胆囊管和胆囊动脉的轴线发生扭转而引起的严重外科急腹症.其临床少见,好发于60～80岁老年女性.欧美文献报告仅400例之多.胆囊扭转的病因不明,但胆囊系膜过长为扭转所必备.胆囊扭转的临床表现无特异性,右上腹痛常见.虽然现代影像学技术有了飞速发展,但胆囊扭转仍无有效特异的影像学诊断方法.实验室检查亦无特异性,常见白细胞数目增高,但肝功能正常.胆囊扭转导致胆囊的血运受阻,胆囊管扭闭,最终导致胆囊坏疽穿孔.但随着早期诊断及外科手术的治疗,其病死率较低.为提高广大临床工作者对该病的了解和重视,在此就胆囊扭转诊治现状做一综述.

Diagnosis and treatment of gallbladder torsion

Gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. It is an unusual and rare occurrence with a predilection for women in their sixth or eighth decades of life. Only about 400 cases have been reported in the literature. The etiology of gallbladder volvulus remains speculative; however, the presence of a redundant mesentery is a prerequisite for torsion. Clinical symptoms are non-specific. Some form of right upper quadrant abdominal pain is nearly always present. Although recent advances in radiographic studies have aided in the diagnosis of many diseases,radiographic studies remain nonspecific in diagnosing gallbladder torsion. Laboratory evaluations are often nonspecific. An elevated white blood cell count is a frequent finding.Liver function tests are commonly normal. Gallbladder volvulus leads to gangrene or perforation because of occlusive obstruction of biliary drainage and blood flow. With early diagnosis and surgical intervention, the disease maintains a low mortality. Here, we present a review of the literature about gallbladder volvulus in order to enhance recognition of gallbladder volvulus.