Wang Ay-Jiun, Wang Tsang-En, Lin Ching-Chung, Lin Shee-Chan, Shih Shou-Chuan
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China.
World J Gastroenterol. 2003 Dec;9(12):2821-3. doi: 10.3748/wjg.v9.i12.2821.
To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).
The medical records of patients hospitalized from January 1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness >3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or abscess.
There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males predominated. Most patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52%, group A) and absent in 25 (group B). Six patients died with a mortality of 12%. Four of the 6 who died were in group A. Patients in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P=0.04) and had a significantly higher white blood cell count (mean 15,885.19 vs. 9,948.40, P=0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band forms. The most commonly cultured bacteria in both blood and bile were E. coli and Klebsiella pneumoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points.
Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC.
评估急性非结石性胆囊炎（AAC）患者的临床信息（包括年龄、实验室数据和超声检查结果）与严重并发症（如坏疽、穿孔或脓肿）之间的关系。
回顾性分析1997年1月至2002年12月期间住院诊断为急性胆囊炎的患者病历，以找出经手术或组织学检查确诊为AAC的患者。收集的数据包括年龄、性别、白细胞计数、谷草转氨酶、总胆红素、碱性磷酸酶、细菌学、死亡率和超声检查结果。超声检查结果按3分制记录，胆囊扩张、胆囊壁厚度>3.5 mm和胆汁淤积各计1分。根据是否存在严重胆囊并发症（定义为穿孔、坏疽或脓肿）将患者分为两组（A组）或不存在（B组）。
共有52例AAC患者，占所有急性胆囊炎病例的3.7%。男性居多。大多数患者通过超声检查（52例中的48例）或计算机断层扫描（52例中的17例）确诊。27例患者（52%，A组）出现严重胆囊并发症，25例（B组）未出现。6例患者死亡，死亡率为12%。死亡的6例患者中有4例在A组。A组患者明显比B组患者年龄大（平均60.88岁对54.12岁，P = 0.04），白细胞计数明显更高（平均15,885.19对9,948.40，P = 0.0005）。所有6例死亡患者白细胞计数正常，但杆状核细胞百分比升高。血液和胆汁中最常培养出的细菌是大肠杆菌和肺炎克雷伯菌。尽管A组的累计超声积分往往更多，但这些积分并不能可靠地区分A组和B组。
白细胞计数高的老年患者更有可能出现严重胆囊并发症。对于这些患者，如果超声检查结果支持AAC的诊断，应考虑更早进行手术干预。
