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目的提高急性非结石性胆囊炎伴罗-阿氏窦穿孔术前确诊率和治愈率。方法回顾性分析5例误诊的急性非结石性胆囊炎伴罗-阿氏窦穿孔病例的临床资料。误诊为十二指肠穿孔2例,胃穿孔1例,急性胰腺炎1例,急性阑尾炎1例,2例先保守治疗后再手术探查,3例入院后急诊手术。术中均发现胆囊水肿及胆囊附近区域有胆汁积聚,未见胆囊坏疽及穿孔,胆囊内无结石。4例行一期胆囊切除术;1例行一期胆囊造瘘,二期胆囊切除术。结果 5例患者均治愈。结论对于不明原因的急性腹膜炎积极行超声检查和腹腔穿刺能提高急性非结石性胆囊炎伴罗-阿氏窦穿孔的确诊率。积极剖腹探查和术中选择个体化的手术方式能提高其治愈率。
Objective To improve the diagnosis and cure rate of acute acalculous cholecystitis with Luo-A-sinuses perforation. Methods A retrospective analysis of 5 cases of misdiagnosed acute acalculous cholecystitis with Luo - A sinus perforated cases of clinical data. Misdiagnosed as duodenal perforation in 2 cases, gastric perforation in 1 case, acute pancreatitis in 1 case, acute appendicitis in 1 case, 2 cases conservative treatment before surgical exploration, 3 cases after admission emergency surgery. Surgery were found gallbladder edema and gallbladder accumulation in the vicinity of the area, no gallbladder gangrene and perforation, no gallbladder stones. 4 routine cholecystectomy; 1 case of a cholecystectomy, two cholecystectomy. Results 5 patients were cured. Conclusions The positive diagnosis of acute acalculous cholecystitis associated with Luo-A-sinuses perforation can be improved by positive ultrasound examination and peritoneal puncture for unexplained acute peritonitis. Positive laparotomy and intraoperative selection of individualized surgical methods can improve the cure rate.