当代坏疽性和非坏疽性急性胆囊炎的治疗结果。
Outcomes of contemporary management of gangrenous and non-gangrenous acute cholecystitis.
机构信息
Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Melbourne, Vic., Australia.
出版信息
HPB (Oxford). 2011 Aug;13(8):551-8. doi: 10.1111/j.1477-2574.2011.00327.x. Epub 2011 Jun 3.
BACKGROUND
Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared with those of non-gangrenous acute cholecystitis (NGAC) are poorly defined and based largely on findings from older studies.
METHODS
Patients with histologically confirmed acute cholecystitis treated in specialized units in a tertiary hospital between 2005 and 2010 were identified from a prospectively maintained database. Data were reviewed retrospectively and patients with GC were compared with those with NGAC.
RESULTS
A total of 184 patients with NGAC and 106 with GC were identified. The risk factors associated with GC included older age (69 years vs. 57 years; P= 0.001), diabetes (19% vs. 10%; P= 0.049), temperature of >38 °C (36% vs. 16%; P < 0.001), tachycardia (31% vs. 15%; P= 0.002), detection of muscle rigidity on examination (27% vs. 12%; P= 0.01) and greater elevations in white cell count (WCC) (13.4 × 10⁹/l vs. 10.7 × 10⁹/l; P < 0.001), C-reactive protein (CRP) (94 mg/l vs. 17 mg/l; P= 0.001), bilirubin (19 µmol/l vs. 17 µmol/l; P= 0.029), urea (5.3 mmol/l vs. 4.7 mmol/l; P= 0.016) and creatinine (82 µmol/l vs. 74 µmol/l; P= 0.001). The time from admission to operation in days was greater in the GC group (median = 1 day, range: 0-14 days vs. median = 1 day, range: 0-10 days; P= 0.029). There was no overall difference in complication rates between the GC and NGAC groups (22% vs. 14%; P= 0.102). There was a lower incidence of common bile duct stones in the GC group (5% vs. 13%; P= 0.017). Gangrenous cholecystitis was associated with increased mortality (4% vs. 0%; P= 0.017), but this was not an independent risk factor on multivariate analysis.
CONCLUSIONS
Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help to differentiate it from NGAC. It is not associated with an overall increase in complications when treated in a specialized unit.
背景
坏疽性胆囊炎（GC）被认为是一种更严重的急性胆囊炎。与非坏疽性急性胆囊炎（NGAC）相比，与这种情况相关的风险因素及其对发病率和死亡率的影响定义不明确，主要基于较旧的研究结果。
方法
从 2005 年至 2010 年在一家三级医院的专门单位接受组织学确诊的急性胆囊炎患者的前瞻性维护数据库中确定了患者。回顾性审查了数据，并将 GC 患者与 NGAC 患者进行了比较。
结果
共确定了 184 例 NGAC 患者和 106 例 GC 患者。GC 的相关危险因素包括年龄较大（69 岁比 57 岁；P=0.001）、糖尿病（19%比 10%；P=0.049）、体温>38°C（36%比 16%；P<0.001）、心动过速（31%比 15%；P=0.002）、检查时发现肌肉僵硬（27%比 12%；P=0.01）和白细胞计数（WCC）更高（13.4×10⁹/l 比 10.7×10⁹/l；P<0.001）、C 反应蛋白（CRP）（94mg/l 比 17mg/l；P=0.001）、胆红素（19µmol/l 比 17µmol/l；P=0.029）、尿素（5.3mmol/l 比 4.7mmol/l；P=0.016）和肌酐（82µmol/l 比 74µmol/l；P=0.001）。GC 组的入院至手术时间中位数为 1 天（范围：0-14 天），而 NGAC 组为 1 天（范围：0-10 天）；P=0.029）。GC 和 NGAC 组之间的并发症发生率总体无差异（22%比 14%；P=0.102）。GC 组胆总管结石的发生率较低（5%比 13%；P=0.017）。坏疽性胆囊炎与死亡率增加有关（4%比 0%；P=0.017），但这不是多变量分析中的独立危险因素。
结论
坏疽性胆囊炎具有某些临床特征和相关的实验室发现，这可能有助于将其与 NGAC 区分开来。在专门的单位进行治疗时，它不会导致并发症总体增加。
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