Contini S, Corradi D, Busi N, Alessandri L, Pezzarossa A, Scarpignato C
Department of Surgery, School of Medicine & Dentistry, University of Parma, Parma, Italy.
J Clin Gastroenterol. 2004 Sep;38(8):710-6. doi: 10.1097/01.mcg.0000135898.68155.88.
BACKGROUND/AIMS: A delay in recognizing and treating an inflamed gallbladder may increase the risk of a necrotic evolution and represent a critical factor affecting the progression of the inflammatory process. Aim of the study is to assess the therapeutic attitude in patients with histologically proved gangrenous cholecystitis, to find out whether it could play a role in the progression of the inflammatory condition.
Twenty-seven patients with gangrenous cholecystitis at histology were compared with a matched-control group with phlegmonous cholecystitis.
Age, gender, ASA score, and concomitant diseases did not differ significantly in both groups. WBC was significantly higher (P = 0.026) in patients with gangrene. Ultrasounds were unhelpful in identifying the severity of the disease. Patients with gangrenous gallbladder showed a significantly increased (P = 0.0006) admission delay compared with controls (104.3+/-15.3 hours vs. 59.7+/-7.7 hours). Surgeon's delay, morbidity and mortality were not different in both groups.
Patient's delay before hospitalization may represent a crucial factor in the progression toward a more severe disease in acute cholecystitis. The time between symptoms onset and hospital admission (and consequently surgery) was significantly longer in patients with gangrenous cholecystitis, further emphasizing the need for an early (if not urgent) surgical treatment in acute cholecystitis, even with mild symptoms.
背景/目的：识别和治疗发炎胆囊的延迟可能会增加坏死进展的风险，并成为影响炎症进程的关键因素。本研究的目的是评估经组织学证实为坏疽性胆囊炎患者的治疗态度，以确定其是否会在炎症病情进展中发挥作用。
将27例组织学诊断为坏疽性胆囊炎的患者与一组配对的蜂窝织炎性胆囊炎对照组进行比较。
两组患者的年龄、性别、美国麻醉医师协会（ASA）评分及合并疾病无显著差异。坏疽患者的白细胞计数显著更高（P = 0.026）。超声检查对确定疾病严重程度并无帮助。与对照组相比，坏疽性胆囊炎患者的入院延迟显著增加（P = 0.0006）（104.3±15.3小时对59.7±7.7小时）。两组的外科医生延误、发病率和死亡率无差异。
患者住院前的延迟可能是急性胆囊炎病情进展为更严重疾病的关键因素。坏疽性胆囊炎患者症状出现至入院（进而至手术）的时间显著更长，这进一步强调了即使症状轻微，急性胆囊炎也需要早期（若非紧急）手术治疗。
