Hamp Thomas, Fridrich Peter, Mauritz Walter, Hamid Laith, Pelinka Linda E
Department of Anesthesiology and Critical Care Medicine, Lorenz-Boehler-Trauma-Hospital of the Austrian Workers' Compensation Board (AUVA), Vienna, Austria.
J Trauma. 2009 Feb;66(2):400-6. doi: 10.1097/TA.0b013e31815edea1.
The goal of this project was to investigate incidence, risk factors, histologic findings, and mortality rate of posttraumatic cholecystitis requiring surgical treatment.
Retrospective analysis of all patients admitted to the intensive care unit of an urban trauma center between April 1998 and January 2005. Data from the hospital and intensive care documentation systems databases and patients' charts were reviewed. All patients with cholecystitis treated by cholecystectomy were selected for further study. Potential risk factors, diagnostic, and histologic findings were analyzed.
Cholecystitis was a fairly frequent finding in critically ill trauma patients (67 of 2,625 patients, 2.6%). Almost 10% of the patients with severe multiple injuries developed cholecystitis. Histologic findings showed a wide variation; three main diagnoses were established: acute acalculous cholecystitis (n = 28), chronic acalculous cholecystitis (n = 25), and cholecystitis with cholecystolithiasis (n = 13). Patients with acute acalculous cholecystitis and chronic acalculous cholecystitis were significantly younger and had significantly higher injury severity scores than patients with either cholecystitis with cholecystolithiasis or without cholecystitis. Noninvasive diagnostic tools such as ultrasonographic signs and laboratory data did not correlate with histologic diagnosis. Well-timed cholecystectomy within 24 hours after clinical suspicion lead to a 4.4% mortality rate in this group of patients.
Cholecystitis after trauma is not a uniform disease. Although trauma severity seems to play an important role in the development or exacerbation of acalculous cholecystitis or both, cholecystolithiasis may play a significant role in patients with moderate to minor trauma. Intensivists should be aware of this complication in critically ill trauma patients because it seems to occur more frequently than previously assumed. Diagnosis can only be made if clinical signs, laboratory data, and ultrasonographic findings are taken into consideration. If posttraumatic cholecystitis is treated in an early stage by cholecystectomy, mortality rate remains low.
本项目旨在调查需要手术治疗的创伤后胆囊炎的发病率、危险因素、组织学表现及死亡率。
对1998年4月至2005年1月间入住一家城市创伤中心重症监护病房的所有患者进行回顾性分析。查阅医院及重症监护病历系统数据库中的数据以及患者病历。选取所有接受胆囊切除术治疗胆囊炎的患者进行进一步研究。分析潜在危险因素、诊断结果及组织学表现。
胆囊炎在重症创伤患者中较为常见（2625例患者中有67例，占2.6%）。近10%的重度多发伤患者发生了胆囊炎。组织学表现差异较大；确立了三种主要诊断：急性非结石性胆囊炎（n = 28）、慢性非结石性胆囊炎（n = 25）以及伴有胆囊结石的胆囊炎（n = 13）。急性非结石性胆囊炎和慢性非结石性胆囊炎患者比伴有胆囊结石的胆囊炎患者或无胆囊炎患者明显更年轻，损伤严重程度评分也明显更高。超声征象和实验室数据等非侵入性诊断工具与组织学诊断不相关。在临床怀疑后24小时内及时进行胆囊切除术，该组患者死亡率为4.4%。
创伤后胆囊炎并非一种单一疾病。尽管创伤严重程度似乎在非结石性胆囊炎的发生或加重中起重要作用，或两者兼而有之，但胆囊结石在中轻度创伤患者中可能起重要作用。重症监护医生应意识到重症创伤患者中的这种并发症，因为其发生频率似乎比之前认为的更高。只有综合考虑临床体征、实验室数据和超声检查结果才能做出诊断。如果创伤后胆囊炎早期通过胆囊切除术治疗，死亡率仍然较低。
