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1、急性非结石性胆囊炎21例诊治研究【摘要】目的探讨急性非结石性胆囊炎(acuteacalculouscholecystitis,AAC)的临床特点与治疗方法。方法回顾性分析我院2000~2008年收治的21例急性非结石性胆囊炎的临床资料。结果本组病例占同期急性胆囊炎病例的11.29%(21/186),均并存有不同程度的系统性疾病,心血管病有高血压、冠心病、心律失常42.9%(9/21);肝脏疾病有脂肪肝、慢性肝炎33.3%(7/21);胆道疾病有胆囊息肉、胆道蛔虫14.3%(3/21);糖尿病23.8%(5/21)。两个系统同时有病者3例。18例行早期胆囊切除术,3例作胆
2、囊造瘘术,其中7例胆囊坏死、穿孔(33.3%),均获得痊愈。术后并发症8例包括切口感染、切口裂开、腹腔感染、肺部感染、应激性溃疡等。21例患者无1例死亡。结论本病进展快,胆囊坏疽、穿孔比例高,术后并发症多,一旦诊断,应积极手术治疗。【关键词】非结石性胆囊炎;外科治疗Clinicalanalysisof21acuteacalculouscholecystitiscasesKONGLiang.TheSixthPeople’sHospitalofDatong,Datong037000,China【Abstract】ObjectiveToinvestigatetheclinic
3、alfeaturesandtreatmentoftheacuteacalculous7cholecystitis(AAC).MethodsThedataof21clinicalacuteacalculouscholecystitiscasesinourhospitalfrom2000to2008wereanalysisretrospectively.ResultsOverthesameperiod,thisgroupofcaseswasaccountedfor11.29%ofallcasesofacutecholecystitis(21/186).All21casese
4、xistwithvaryingdegreesofsystemicdiseases.Thecardiovasculardiseaseswerehypertension,coronaryheartdisease,arrhythmia42.9%(9/21).Theliverdiseaseswerefattyliver,chronichepatitis,33.3%(7/21).Thebiliarytractdiseasesweregallbladderpolyps,biliaryascariasis14.3%(3/21)andtherewerediabetes,23.8%(5/
5、21).Therewere3caseseffectedintwosystemsatthesametime.18casesunderwentearlycholecystectomy,cholecystostomyforthreecases,including7casesofgallbladdernecrosis,perforation(33.3%),andbothwerecured.8casesofpostoperativecomplications,includingwoundinfection,wounddehiscence,intra-abdominalinfect
6、ions,lunginfections,suchasstressulcer.Nonpatientdied.ConclusionAACprogressedrapidlyand7hasahighproportionofpostoperativecomplicationssuchasgallbladdergangrene,perforation.Iftherehasgettheconfirmeddiagnosis,theoperationshouldbeactivelydone.【Keywords】Acalculouscholecystitis;Surgicaltreatme
7、nt急性非结石性胆囊炎(acuteacalculouscholecystitis,AAC)是指胆囊壁有明显的炎症改变而胆囊内无结石存在,1884年由Pumcan首次报道。AAC的发病率国内报道约占急性胆囊炎的5%~20%,国外报道占2%~12%,近年来发病率有增高趋势,而且门诊病例也有增加[1]。2000年1月至2008年12月,我院共收治资料完整的手术治疗的急性胆囊炎患者186例,其中急性非结石性胆囊炎(acuteacalculouscholecystitis,AAC)21例,急性结石性胆囊炎(acutecalculouscholecy
