腹部手术后急性非结石性胆囊炎诊治策略  

Diagnosis and Treatment of Acute Acalculous Cholecystitis after Abdominal Operation

作　　者：郑建伟[1] 曹李[2] 吴安健[2] 董光龙[2] Zheng Jianwei;Wu Anjian;Dong Guanglong(Department of General Surgery,Aerospace Center Hospital,Beijing 100049,China;Department of General Surgery,General Hospital of PIA,Beijing 100853,China)

机构地区：[1]航天中心医院普通外科,北京100049 [2]解放军总医院普通外科,北京100853

出　　处：《中华普外科手术学杂志（电子版）》2018年第3期219-222,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.8177110076);解放军总医院临床科研扶持基金(No.2016FC-TSYS-2033)~~

摘　　要：目的对腹部手术之后急性非结石性胆囊炎的诱因、临床症状和相关治疗措施进行研究。方法回顾性分析2012年1月至2017年1月20例腹部手术后急性非结石性胆囊炎的病历资料。结果只有2例表现出上腹轻压痛,还没有出现腹膜炎的相关体征,超声提示胆囊壁水肿状况一般,胆囊附近没有积液,行抗炎、纠正微循环保守治疗后好转。7例患者因年龄较大、病情危重,暂行经皮经肝胆囊穿刺置管引流术(PTGD),其中1例因引流效果不佳,开腹行胆囊切除;1例因并发感染性休克、呼吸衰竭死亡;其余5例病情稳定后3月均行腹腔镜胆囊切除术。11例患者均直接行胆囊切除术,其中行开腹手术3例,腹腔镜手术8例,因腹腔粘连严重中转开腹3例。2例患者因怀疑有胆总管穿孔可能,加胆总管探查T管引流术。结论腹部手术之后出现急性非结石性胆囊炎是由多种诱因共同作用的结果,易于与原发疾病的并发症相混淆,出现误诊或者漏诊,且急性非结石性胆囊炎可诱发多器官功能衰竭,故及早发现、及早诊断并根据患者的耐受情况选择合理的手术切除是最佳治疗手段。Objective To investigate the cause,clinical characteristics,diagnosis and treatment of acute calculous cholecystitis after abdominal operation. Methods From January 2012 to January 2017,clinical data of 20 patients with acute calculous cholecystitis who underwent abdominal operation were retrospectively analyzed. Results Two patients only developed mild tenderness on the upper abdomen without peritonitis signs,and the ultrasound indicated edema of gallbladder wall was not serious without effusion around the gallbladder,and these two patients improved after receiving conservative treatments of anti-infection and microcirculation correction. Seven patients received PTGD temporarily as they were aged and in critical conditions,one patient received cholecystectomy under laparotomy due to unsatisfactory drainage effect; one patient died of complications of infectious shock and respiratory failure; and the other five patients received cholecystectomy under laparoscopy three months after their conditions stabilized. All the rest 11 patients received cholecystectomy directly,of whom,three patients received laparotomy,eight patients underwent laparoscopic surgery and three of them converted to open surgery due to serious abdominal adhesion. Two patients additionally received common bile duct exploration and T tube drainage as they were suspected of perforation of common bile duct. Conclusion Acute acalculous cholecystitis after abdominal operations is caused by multiple factors,which is easily confused with complications of primary diseases,leading to misdiagnosis or missed diagnosis. In addition,as acute acalculous cholecystitis could devolop multiple organ failure,the optimal treatment approach should be early identified and early diagnosis and reasonable surgical resection might be performed based on patients＇ tolerability.

关 键 词：无结石性胆囊炎 剖腹术 诊断技术和方法 

分 类 号：R657.41[医药卫生—外科学]