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投稿时间：2020-09-11 网络发布日期：2021-07-20
投稿时间：2020-09-11 网络发布日期：2021-07-20
中文摘要: 目的总结急性胆囊炎并发胆囊穿孔(GBP)的临床特征,探讨其病因、诊断及治疗方法。方法选取2014年1月至2020年1月收治的1 432例急性胆囊炎中30例并发GBP患者为对象进行回顾性研究,分析其临床特征、影像学特征、诊治经过及预后。结果1 432例急性胆囊炎并发GBP 30例,GBP发生率2.1%;其中男性19例,女性11例;年龄41～80岁;按Niemeier分型,I型穿孔6例(主要表现显著的腹膜刺激征),Ⅱ型穿孔22例(主要表现腹痛和发热、Murphy征阳性),Ⅲ型穿孔2例(主要表现厌食、腹胀、恶心、呕吐等);有胆囊结石病史者24例,20例患者术前合并有多种基础疾病。所有患者均经术前影像学检查或术中探查确诊为GBP,其中术中诊断10例。除2例患者保守治疗好转后,其余28例根据不同型别的临床特点行不同手术治疗(包括腹腔灌洗引流术、经皮肝胆囊穿刺引流术、开腹或腹腔镜胆囊切除术、瘘修补术等)。术后出现并发症15例,死亡3例,病死率10.0%。30例中20例患者出院后获6～36个月随访,4例出院后胆管结石复发,2例并发胆管炎,1例出现肠梗阻,1例因肺癌死亡,其余12例无并发症、健康生存。结论GBP以老年男性多见,各型穿孔的临床特征有所不同,术前影像学检查易漏诊或误诊;对GBP患者进行早期诊断并按其分型采取及时的外科干预具有重要的临床意义。
Abstract:Objective To summarize the clinical features of acute cholecystitis complicated with gallbladder perforation(GBP),and to explore its etiology,diagnosis and treatment.
Methods Among the 1 432 patients with acute cholecystitis admitted from January 2014 to January 2020, 30 patients with GBP were selected for retrospective study to analyze their clinical features,imaging characteristics,diagnosis,treatment and prognosis.
Results The incidence of GBP was 2.1%(30/1 432).There were 19 males and 11 females,and age ranged from 41 to 80 years.According to Niemeier classification,there were 6 cases of type Ⅰ perforation (mainly manifestations of peritoneal irritation),22 cases of type Ⅱ perforation (mainly manifestations of abdominal pain,fever and positive Murphy′s sign) and 2 cases of type Ⅲ perforation (mainly manifestations of anorexia,abdominal distension,nausea and vomiting,etc.).There were 24 cases with history of gallstone disease and 20 cases with multiple underlying diseases before operation.All patients were confirmed as GBP by preoperative imaging or intraoperative exploration(10 cases).Two patients got improved after conservative treatment,and the remaining 28 patients underwent different surgical treatments according to the clinical characteristics of different types (including
peritoneal lavage and drainage,percutaneous transhepafic gallbladder drainag,laparotomy or laparoscopic cholecystectomy and fistula repair,etc.).Postoperative complications occurred in 15 patients,and 3 patients died,with a mortality rate of 10.0%.Of 20 patients followed up for 6-36 months after discharge,there were 4 cases of recurrent bile duct stones,2 cases of cholangitis,1 case of intestinal obstruction and 1 case died of lung cancer,and the remaining 12 patients had healthy survival without complications.
Conclusions GBP is common in elderly men,with different clinical characteristics in each type of perforation.Preoperative imaging characteristics is easy to be missed or misdiagnosed.Early diagnosis and timely surgical intervention according to their classification has important clinical significance for GBP patients.
keywords: Acute cholecystitis Gallbladder perforation Niemeier classification Drainage Cholecystectomy Fistula repair
文章编号： 中图分类号：R657.4 文献标志码：B
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引用文本：
朱彩鹏,何敏,巢凯,黎昭君,唐继红.急性胆囊炎并发胆囊穿孔的临床特征及诊疗分析[J].中国临床研究,2021,34(7):913-917.
朱彩鹏,何敏,巢凯,黎昭君,唐继红.急性胆囊炎并发胆囊穿孔的临床特征及诊疗分析[J].中国临床研究,2021,34(7):913-917.