Chowbey Pradeep K, Venkatasubramanian R, Bagchi Nabanita, Sharma Anil, Khullar Rajesh, Soni Vandana, Baijal Manish
Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India.
J Laparoendosc Adv Surg Tech A. 2007 Feb;17(1):43-6. doi: 10.1089/lap.2006.05078.
Emergency cholecystectomy for acute cholecystitis in critically ill patients with organ failure and sepsis carries a high risk of morbidity and mortality. Temporizing interventions such as laparoscopic cholecystostomy can help the patient to recover from the critical illness by deferring the definitive procedure to a later, safer period. We describe our experience of laparoscopic cholecystostomy performed in two critically ill patients. In the first case, a 56-year-old man with hypertension, diabetes, and ischemic heart disease, was admitted for evaluation of malena. During the course of his stay, he developed acute calculous cholecystitis, acute renal failure, and right pleural effusion. In the second case, a 68-year-old man presented with diabetes, hypertension, diabetic nephropathy, acute chronic renal failure, and acute calculous cholecystitis. Both patients failed to improve with conservative measures and underwent laparoscopic cholecystostomy under local anesthesia and sedation in view of severe comorbidities and sepsis. Both patients recovered from sepsis. Laparoscopic cholecystectomy was performed uneventfully after six and eight weeks, respectively, and both patients were doing well at one-year follow-up.
对于伴有器官衰竭和脓毒症的危重症患者，因急性胆囊炎而行急诊胆囊切除术具有较高的发病率和死亡率风险。诸如腹腔镜胆囊造口术等临时性干预措施，可通过将确定性手术推迟至更晚、更安全的时期，帮助患者从危重症中康复。我们描述了在两名危重症患者中实施腹腔镜胆囊造口术的经验。第一例，一名56岁男性，患有高血压、糖尿病和缺血性心脏病，因黑便入院评估。住院期间，他并发了急性结石性胆囊炎、急性肾衰竭和右侧胸腔积液。第二例，一名68岁男性，患有糖尿病、高血压、糖尿病肾病、急性慢性肾衰竭和急性结石性胆囊炎。鉴于严重的合并症和脓毒症，两名患者经保守治疗均无改善，遂在局部麻醉和镇静下接受了腹腔镜胆囊造口术。两名患者的脓毒症均得以康复。分别在六周和八周后顺利进行了腹腔镜胆囊切除术，在一年的随访中，两名患者情况良好。
