探讨急性坏疽性胆囊炎的诊疗分析

目的:探讨分析急性坏疽性胆囊炎的相关危险因素和治疗临床效果。方法:分析我院2002年1月至2012年1月收治的因急性胆囊炎行胆囊切除术患者的临床资料,共422例。依据手术后的病理检查结果分为急性坏疽性胆囊炎组和急性单纯性胆囊炎组,分别为124例(29.38%)和298例(60.62%)。急性坏疽性胆囊炎患者随机分为两组,分别采用腹腔镜治疗74例,剖腹胆囊切除术治疗50例。结果:急性坏疽性胆囊炎占急性胆囊炎的30.1%,与急性单纯性胆囊炎相比在发病因素上有明显的差异,分别经相应的统计学检验,差异显著具有统计学意义(P<0.05)。差异性发病因素主要有患者年龄、性别、CRP、肝硬化、糖尿病、白细胞计数、胆囊周围积液、胆囊增大、胆囊壁厚度等。通过多因素分析发现年龄、性别、糖尿病和白细胞计数这4个因素为急性坏疽性胆囊炎的独立主要因素。通过对患者术中和术后的各项指标的检测统计分析,对于急性坏疽性胆囊炎治疗腹腔镜临床疗效要优于开腹手术切除,差异显著具有统计学意义(P<0.05)。结论:急性坏疽性胆囊炎最主要的危险因素有年龄、性别、糖尿病和白细胞计数,临床工作中应当密切注意这些方面对于诊断有很大的帮助。急性坏疽性胆囊炎在治疗方式上腹腔镜治疗效果优于普通开腹手术治疗,值得在临床推广应用。

Investigation and clinical analysis on acute gangrenous cholecystitis

Objective:To investigate the risky factors associated with analysis of acute gangrenous cholecystitis and treatment of clinical effect.Methods: Analyze the medical records of 422 acute cholecystitis patients who are admitted to our hospital and had an operation of cholecystectomy from January 2002 to January 2012.Based on pathological examination results after surgery,the patients were divided into acute gangrenous cholecystitis group and acute uncomplicated cholecystitis group.And the two groups include 124 cases(29.38%) and 298 cases(60.62%).The patients in acute gangrenous cholecystitis group were randomly divided into two groups,respectively,using the laparoscopic treatment of 74 cases while 50 cases with laparotomy cholecystectomy.Results: Acute gangrenous cholecystitis accounted for 30.1% of acute cholecystitis.Compared with acute uncomplicated cholecystitis,there are significant differences in the epidemic factors.According to the relevant statistical tests respectively,the difference was statistically significant(P<0.05).The differences of epidemic factors are the patients' age,gender,CRP,cirrhosis,diabetes,white blood cell count,gallbladder surrounding effusion,enlargement of the gallbladder,gallbladder wall thickness and so on.Among them,the age,gender,diabetes,and white blood cell count are the main four independent factors of acute gangrenous cholecystitis based on multivariate analysis.According to the detection,statistical data and analysis of patients' intraoperative and postoperative indexes,clinical efficacy for the treatment of acute gangrenous cholecystitis laparoscopic is better than open surgery resection.The difference was statistically significant(P<0.05).Conclusion: The main risky factors of acute gangrenous cholecystitis are age,gender,diabetes,and white blood cell count.Clinical work should pay close attention to these areas,which are of great help for the diagnosis.Acute gangrenous cholecystitis laparoscopic is better than ordinary open surgery and the former one is worthy of clinical application.