Wind P, Sales J P, Lowenstein W, Berger A, Frileux P, Cugnenc P H
Service de Chirurgie digestive et générale, Hôpital Laennec, Paris.
Presse Med. 1992 Nov 28;21(40):1901-4.
In AIDS patients an acalculous cholecystitis may be responsible for abdominal pain subsiding after cholecystectomy. But the indications for cholecystectomy are not clear: cholecystitis is usually associated with diffuse cholangitis and this might cause the symptoms. Since 1985, 8 AIDS patients have undergone cholecystectomy for acute cholecystitis. Ultrasonography revealed a 5 to 12 mm thickening of the gallbladder wall in all of them and gallbladder stones in two; four patients had cholangitis. The decision to operate was based on persistent pain associated with fever, poor general condition and muscular rigidity at palpation. Four patients had septic shock at the time of surgery; one died in the immediate postoperative period. In all other patients pain and septic syndrome subsided. Two patients died of AIDS complications 20 days after surgery; the remaining five died of AIDS 6, 9, 10, 12 and 14 months respectively after surgery; in two of them cholestasis had reappeared due to cholangitis. To summarize, in the 8 AIDS patients studied cholecystectomy was performed for clinical deterioration. Gallbladder pathology was responsible for the abdominal pain and the febrile general condition which was relieved by cholecystectomy.
在艾滋病患者中，无结石性胆囊炎可能是胆囊切除术后腹痛缓解的原因。但胆囊切除术的指征尚不清楚：胆囊炎通常与弥漫性胆管炎相关，这可能是症状的起因。自1985年以来，8例艾滋病患者因急性胆囊炎接受了胆囊切除术。超声检查显示，所有患者胆囊壁增厚5至12毫米，其中2例有胆囊结石；4例患者有胆管炎。手术决定基于持续疼痛伴发热、一般状况差以及触诊时有肌肉紧张。4例患者在手术时发生感染性休克；1例在术后即刻死亡。所有其他患者的疼痛和感染综合征均消退。2例患者在术后20天死于艾滋病并发症；其余5例分别在术后6、9、10、12和14个月死于艾滋病；其中2例因胆管炎再次出现胆汁淤积。总之，在研究的8例艾滋病患者中，进行胆囊切除术是为了改善临床状况。胆囊病变是腹痛和发热全身状况的原因，胆囊切除术后这些症状得到缓解。
