Gouma D J, Obertop H
Department of Surgery, University Hospital Maastricht.
HPB Surg. 1992;6(2):69-78. doi: 10.1155/1992/46529.
The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70-80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.
近年来，急性结石性胆囊炎患者的治疗方式发生了变化。急性胆囊炎的病因仍未完全明确。由于许多急性胆囊炎患者的胆汁和胆囊壁培养结果为无菌，胆汁感染相对来说并不重要。超声检查是诊断急性胆囊炎的首选方法，胆囊闪烁造影是次选方法。可用于治疗性引流的经皮胆囊穿刺也具有诊断价值。在抗生素预防下早期进行胆囊切除术是首选的治疗方法，并且在多项前瞻性试验中已证明其优于延迟手术。70 - 80岁以下患者的死亡率可低至0.5%，但据报道，80多岁的患者死亡率较高。选择性术中胆管造影目前已被普遍接受，临床试验未显示常规胆管造影有任何优势。在超声引导下可成功进行经皮胆囊造瘘术，其在急性胆囊炎重症患者的治疗中占有一席之地。急性胆囊炎患者可安全地进行腹腔镜胆囊切除术，但需要有该技术的丰富经验。通过在胆囊管插入导管进行内镜逆行胆囊引流是可行的，但相关数据仍然较少。
