胆囊扭转诊断与管理的临床指南
A Clinician's Guide to the Diagnosis and Management of Gallbladder Volvulus.
作者信息
Pottorf Brian J, Alfaro Leonardo, Hollis Harris W
机构信息
Department of Graduate Medical Education, Exempla St Joseph Hospital in Denver, CO, USA.
出版信息
Perm J. 2013 Spring;17(2):80-3. doi: 10.7812/TPP/12-118.
INTRODUCTION
Gallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. We examine the history of gallbladder torsion and highlight the critical constellation of presenting signs and symptoms, which guide the acute care physician and surgeon to accurate and timely diagnosis of GV before surgical intervention.
METHODS
A comprehensive review of all published cases of GV was performed using the National Library of Medicine (PubMed) database.
RESULTS
Lists of typical symptoms and clinical presentations are provided to allow clinicians to establish an accurate preoperative diagnosis.
CONCLUSION
GV is frequently undiagnosed before surgical intervention. However, clinical presentation and associated radiographic findings can lead to an accurate diagnosis if the clinician is aware of this uncommon condition. When the diagnosis has been established before operative intervention, expeditious laparoscopic cholecystectomy can be performed safely. Delays in diagnosis may mandate open cholecystectomy if laparoscopic extraction is contraindicated because of undesirable sequelae of gallbladder necrosis, specifically perforation, bilious peritonitis, and hemodynamic instability.
引言
胆囊扭转（GV），即胆囊发生扭转，是一种罕见的外科急症。本文回顾了与胆囊扭转相关的世界文献。我们研究了胆囊扭转的历史，并强调了关键的体征和症状组合，这些体征和症状可指导急诊医生和外科医生在手术干预前准确、及时地诊断胆囊扭转。
方法
使用美国国立医学图书馆（PubMed）数据库对所有已发表的胆囊扭转病例进行了全面回顾。
结果
提供了典型症状和临床表现列表，以便临床医生进行准确的术前诊断。
结论
胆囊扭转在手术干预前常常未被诊断出来。然而，如果临床医生了解这种罕见疾病，临床表现及相关影像学检查结果可有助于准确诊断。在手术干预前确诊后，可安全地进行快速腹腔镜胆囊切除术。如果因胆囊坏死的不良后果（特别是穿孔、胆汁性腹膜炎和血流动力学不稳定）而禁忌腹腔镜摘除，诊断延迟可能需要进行开腹胆囊切除术。
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