中-重度急性胆囊炎与穿孔的指标对比研究  

Comparative study of indicators of moderate-severe acute cholecystitis and perforation

作　　者：何晓非[1] 陈永平 刘向东 HE Xiaofei;CHEN Yongping;LIU Xiangdong(Department of Hepatobiliary Surgery,Zigong Fourth People′s Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第四人民医院肝胆外科,四川自贡643000

出　　处：《现代医药卫生》2025年第4期878-880,886,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨影像学联合部分实验室指标在鉴别急性胆囊穿孔(AGP)和中-重度急性胆囊炎(AC)中的价值。方法回顾性收集2010年12月至2023年12月该院经手术病理证实的23例AGP患者,作为AGP组;另收集同期手术病理证实中-重度AC患者40例,作为AC组;对比分析2组患者影像学及部分实验室指标的差异。结果AGP组患者胆囊结石位于胆囊颈部、发生胆囊瘘占比高于AC组[65.22%(15/23)vs.20.00%(8/40)、65.22%(15/23)vs.7.50%(3/40)],差异均有统计学意义(P<0.05);AGP组患者中白细胞(WBC)≥15.0×10^(9)L^(-1)占比高于AC组[73.91%(17/23)vs.37.50%(15/40)],差异有统计学意义(P<0.05)。2组患者在胆囊体积、结石长径、胆囊窝积液、胆囊壁厚度及降钙素原、超敏C反应蛋白、碱性磷酸酶、清蛋白、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素方面,差异均无统计学意义(P>0.05)。结论胆囊瘘口、胆囊结石位置及WBC计数在鉴别AGP及中-重度AC中有重要的临床意义。熟悉相关影像学及实验室检查,可以在一定程度上降低误诊及漏诊。Objective To investigate the value of imaging combined with some laboratory indicators in the differential diagnosis of acute gallbladder perforation(AGP)and moderate to severe acute cholecystitis(AC).Methods A total of 23 patients with AGP confirmed by surgery and pathology in the hospital from December 2010 to December 2023 were retrospectively collected as AGP group.In addition,40 patients with moderate to severe AC confirmed by surgery and pathology were collected as AC group.The differences of imaging and some laboratory indicators between the two groups were compared and analyzed.Results The proportion of gallbladder stones located in the neck of the gallbladder and the proportion of gallbladder fistulas in the AGP group were both higher than those in the AC group[65.22%(15/23)vs.20.00%(8/40),65.22%(15/23)vs.7.50%(3/40)],and the differences were statistically significant(P<0.05).The proportion of white blood cell(WBC)≥15.0×109 L-1 in the AGP group was higher than that in the AC group[73.91%(17/23)vs.37.50%(15/40)],and the difference was statistically significant(P<0.05).There were no significant differences in gallbladder volume,stone length,gallbladder fossa effusion,gallbladder wall thickness,procalcitonin,high-sensitivity C-reactive protein,alkaline phosphatase,albumin,aspartate aminotransferase,a lanine aminotransferase and total bilirubin between the two groups(P>0.05).Conclusion Gallbladder fistula,gallstone location and WBC count have important clinical significance in the identification of AGP and moderate to severe AC.Familiarity with relevant imaging and laboratory examinations can reduce misdiagnosis and missed diagnosis to a certain extent.

关 键 词：胆囊穿孔 急性胆囊炎 瘘口 结石位置 影像学 白细胞 

分 类 号：R575.6[医药卫生—消化系统]