1例超高龄老人急性非结石性胆囊炎伴胆囊穿孔致巨大肝包膜下积液的诊治分析  

Diagnostic and therapeutic analysis of a case of acute noncalculous cholecystitis with gallbladder perforation resulting in a huge subperitoneal hepatic effusion in an ultra-elderly old man

作　　者：许逢燕 李佳婧 陈举海 马文 向凝 XU Fengyan;LI Jiajing;CHEN Juhai;MA Wen;XIANG Ning(ComprehensiveWard,the Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou,550004,China;Internal Medicine Department of the ThreeWard,Guiyang Public Clinical Health Center,Guiyang,Guizhou,550004,China)

机构地区：[1]贵州医科大学附属医院综合病房,贵州贵阳550004 [2]贵阳市公共卫生救治中心内三科,贵州贵阳550004

出　　处：《当代医学》2024年第16期113-117,共5页Contemporary Medicine

摘　　要：老年人急性非结石性胆囊炎是临床上极凶险的急腹症,病情重,易导致胆囊穿孔、胆囊坏疽、肝脓肿等严重并发症,尤其超高龄老年人,通常无典型腹痛症状及腹膜炎体征,症状与病情严重程度不相符,极易出现漏诊,且超高龄患者常多病共存,病情复杂且重,手术风险大,可能无法行胆囊切除术及胆囊引流术,治疗选择有限,从而导致预后不佳,因此,对反复纳差、炎症指标升高、感染灶无法明确的患者,需及时完善胆囊B超或CT,及早发现并治疗。贵州医科大学附属医院收治1例急性非结石性胆囊炎伴胆囊穿孔的超高龄患者,该患者出现胆囊穿孔伴极少见的巨大肝包膜下积液,本文分析其发病及治疗特点,提高医务人员对该病的认识及诊治。Acute noncalculous cholecystitis in the elderly is the clinically very dangerous acute abdominal disease,the condition is serious,prone to gallbladder perforation,gangrene of the gallbladder,liver abscess and other serious complications,especially in the ultra-elderly elderly,usu-ally without the typical symptoms of abdominal pain and signs of peritonitis,and the symptoms do not correspond to the severity of the disease,it is very easy to miss the diagnosis,and super-elderly patients often have multiple coexisting diseases,which are complex and heavy,with high surgical risk,may not be able to perform cholecystectomy and cholecystic drainage,and have limited treatment choices,which leads to poor prognosis.There-fore,patients with recurrent poor natriuresis,elevated inflammatory indexes,and undefined foci of infection need to improve the gallbladder ultra-sound or CT in a timely manner,so as to detect and treat them at an early stage.A case of acute noncalculous cholecystitis with gallbladder perfora-tion was admitted to the Affiliated Hospital of Guizhou Medical University in a super-elderly patient,who presented with gallbladder perforation ac-companied by the very rare huge subperitoneal hepatic effusion,and this paper analyzes its pathogenesis and therapeutic characteristics to improve the medical staff's understanding and diagnosis of this disease.

关 键 词：急性非结石性胆囊炎 胆囊穿孔 巨大肝包膜下积液 

分 类 号：R657.41[医药卫生—外科学]