摘要
目的:探讨手术后急性非结石性胆囊炎(AAC)的发生原因、诊断及治疗。方法:回顾性分析1986—2008年手术治疗84例原手术后急性非结石性胆囊炎的临床资料。结果:男性54例,女性30例。平均年龄53岁。手术后AAC发生于术后5～32 d。由于AAC的特点与一般急性结石性胆囊炎相近似症状的干扰,对其认识不足、易误诊、误诊率达76.2%。腹腔或非腹腔疾病手术后突然右上腹持续性疼痛,明显腹膜刺激征,辅以BUS或CT检查即可确诊;若早期虽未确诊,亦应剖腹探查术,以防延误治疗。根据术中病情及病变局部情况,可分别选择胆囊切除或胆囊大部切除术、腹腔引流术以及胆囊造口术、腹腔引流术,待6个月后再行胆囊切除术。本组78例治愈,2例胆囊造口术亦痊愈;4例延误治疗中毒性休克死亡,病死率4.8%。结论:手术后AAC是一种临床经过凶险的术后并发症之一,术前误诊率高达76.2%,提高对手术后AAC的认识水平,结合临床特点及BUS或CT检查,可提高诊断率。
Objective： To investigate etiology,diagnosis and treatment of postoperative acute acalculous cholecystitis.Method： Clinical data of 84 cases of postoperative AAC was analyzed retrospectively from 1986 to 2008.Result： 54 cases were male,30 cases female.AAC occurred in 5 d to 32d after operation.Misdiagnosis rate of postoperative AAC was 76.2%,because of similar symptom and insufficient understanding.Confirmed diagnosis depended on right up abdominal pain,peritoneal irritation sign and the result of BUS and CT.Operating in time and choosing the proper operation form according to the operational situation are the way to cure the disease.Operation type included of cholecystectomy,partial cholecystectomy,cholecystostomy and abdominal drainage.78 cases were cured,4 cases dead of septic shock（mortality rate 4.8%）.Conclusion： Postoperative AAC was one of serious postoperative complications.Misdiagnosis rate was high to 76.2%.sufficient understanding combined with clinical characteristics and the rusult of BUS and CT can improve diagnosis rate.
出处
《中国现代普通外科进展》
CAS
2011年第12期925-927,共3页
Chinese Journal of Current Advances in General Surgery
