急性进展迅速型坏疽性胆囊炎的危险因素分析  

Analysis of risk factors of acute rapidly progressing gangrenous cholecystitis

作　　者：刘南斌 李堃 魏玉华 许艳 陈泉宁[1] 施宝民[1] Liu Nanbin;Li Kun;Wei Yuhua;Xu Yan;Chen Quanning;Shi Baomin(Department of General Surgery,Affiliated Tongji Hospital,Tongji University,Shanghai 200333,China)

机构地区：[1]同济大学附属同济医院普通外科,上海200333

出　　处：《腹部外科》2021年第2期149-153,共5页Journal of Abdominal Surgery

摘　　要：目的探讨急性进展迅速型坏疽性胆囊炎的危险因素。方法回顾性分析同济大学附属同济医院肝胆外科2013年1月至2019年12月收治的急性坏疽性胆囊炎病人临床资料,采用Logistic回归分析方法分析性别、年龄、高血压、糖尿病、最高体温、白细胞计数、C反应蛋白、墨菲征、胆囊周围积液、胆囊壁线性中断、胆囊结石颈部嵌顿与急性进展迅速型坏疽性胆囊炎的关系。结果单因素回归分析发现,年龄≥60岁、糖尿病、最高体温≥38℃、胆囊壁增厚≥4 mm、胆囊壁线性中断、胆囊结石颈部嵌顿及白细胞计数≥15×109/L、C反应蛋白≥200 mg/L是坏疽性胆囊炎的危险因素。白细胞计数≥15×109/L、C反应蛋白≥200 mg/L、墨菲征阳性、胆囊壁线性中断、结石颈部嵌顿是急性进展迅速型坏疽性胆囊炎的危险因素。多因素回归分析发现,胆囊结石颈部嵌顿是急性进展迅速型坏疽性胆囊炎的独立危险因素。结论急性进展迅速型坏疽性胆囊炎属于临床危急重症,常被误认为一般性胆囊炎,延误治疗。该病更需要加强认识,早期诊断和及时处理尤为重要。胆囊结石颈部嵌顿是其独立危险因素。Objective To explore the risk factors of acute rapidly progressing gangrenous cholecystitis.Methods Retrospective analysis was performed for clinical data of patients hospitalized with acute gangrenous cholecystitis from January 2013 to December 2019.Logistic regression analysis was utilized for analyzing gender,age,hypertension,diabetes mellitus and body temperature.The relationship between leukocyte count,C-reactive protein,Murphy sign,fluid accumulation around gallbladder,linear interruption of gallbladder wall,stone neck incarceration and acute progressive gangrene cholecystitis.Results Univariate regression analysis revealed that age≥60 years,diabetes mellitus,body temperature≥38℃,gallbladder wall thickening≥4 mm,linear interruption of gallbladder wall,stone incarceration in gallbladder neck,leucocyte≥15×109/L and C-reactive protein≥200 mg/L were risk factors of gangrenous gallbladders.Leucocyte count≥15×109/L,C-reactive protein≥200 mg/L,positive Murphy sign,linear interruption of gallbladder wall and stone neck incarceration were risk factors for acute rapidly progressing gangrenous cholecystitis.Multivariate regression analysis indicated that stone incarceration was an independent risk factor for cholecystitis indicator and there was acute rapid progression of gangrene.Conclusion As a critical and severe disease,acute progressing gangrenous cholecystitis is often mistaken for general cholecystitis and treatment is thus delayed.Clinicians should raise the awareness and early diagnosis and timely treatment are particularly important.Stone neck incarceration is an independent risk factor.

关 键 词：坏疽性胆囊炎 危险因素 回归分析 

分 类 号：R657.42[医药卫生—外科学]