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目的探讨急性非结石性胆囊炎(AAC)的临床特点、诊断及治疗方法。方法对2010年10月至2016年8月期间笔者所在医院收治的56例急性非结石性胆囊炎患者的相关临床资料进行回顾性分析。结果 56例患者均施以外科治疗。44例患者行手术治疗,其中行开腹胆囊切除手术10例;腹腔镜胆囊切除手术(LC)34例,其中有6例中转开腹手术,全部手术患者均病情恢复良好,无重大并发症发生。另12例患者行经皮经肝胆囊穿刺置管引流术(PTGD)治疗,其中8例患者4周后行LC;4例患者症状缓解4周后拔除胆囊穿刺管,拒绝手术治疗,其中3例患者于拔管后4~6周复发AAC,急诊行LC,另1例患者AAC未复发。结论彩超、CT、血生化检验及临床表现是早期诊断急性非结石性胆囊炎的主要方法。外科手术是防止胆囊穿孔、降低并发症和死亡率的重要措施。早期(尤其是发病后72 h内)行腹腔镜胆囊切除术是安全、可行的。PTGD可作为AAC高危患者的一种安全、有效的急诊处置手段,可为危重患者病情恢复创造条件,为择期手术赢得机会。
Objective To investigate the clinical features, diagnosis and treatment of acute acalculous cholecystitis (AAC). Methods The clinical data of 56 patients with acute acalculous cholecystitis admitted to our hospital from October 2010 to August 2016 were analyzed retrospectively. Results 56 patients were treated with surgery. Forty-four patients underwent surgical treatment, including 10 cases undergoing open cholecystectomy. Among them, laparoscopic cholecystectomy (LC) was performed in 34 cases. Among them, 6 cases underwent laparotomy, and all the patients underwent surgery. No serious complication occurred . The other 12 patients underwent percutaneous transhepatic gallbladder catheterization (PTGD), of which 8 patients underwent LC 4 weeks later. Four patients were relieved of gallbladder puncture after 4 weeks of symptom remission, and 3 patients were excluded from surgery Recurrence of AAC 4 to 6 weeks after the tube, emergency line LC, and the other patients did not relapse AAC. Conclusion The main methods of early diagnosis of acute acalculous cholecystitis are color Doppler ultrasonography, CT, blood biochemical examination and clinical manifestations. Surgery is to prevent gallbladder perforation, reduce complications and mortality an important measure. Early (especially within 72 h after onset) laparoscopic cholecystectomy is safe and feasible. PTGD can be used as a safe and effective emergency treatment for high-risk AAC patients, which can create conditions for the recovery of critically ill patients and win the chance for elective surgery.