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坏疽性胆囊炎:死亡率及危险因素

Gangrenous cholecystitis: mortality and risk factors.

作者信息

Önder Akın, Kapan Murat, Ülger Burak Veli, Oğuz Abdullah, Türkoğlu Ahmet, Uslukaya Ömer

机构信息

Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.

出版信息

Int Surg. 2015 Feb;100(2):254-60. doi: 10.9738/INTSURG-D-13-00222.1.

Abstract

As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

摘要

坏疽性胆囊炎作为胆结石的一种严重并发症,其死亡率高于非复杂性胆囊炎。本研究的目的是明确影响死亡率的危险因素。对1997年1月至2011年10月间因坏疽性胆囊炎接受手术的107例连续患者进行了回顾性研究。该研究包括60例(56.1%)女性和47例(43.9%)男性,平均年龄为60.7±16.4(21 - 88)岁。心血管疾病是最常见的伴随疾病(24.3%)。29例患者出现了36种并发症(33.6%),手术部位感染被证实是最常见的。入院前延迟时间较长、白细胞计数低、存在糖尿病、天冬氨酸转氨酶、丙氨酸转氨酶、碱性磷酸酶和总胆红素的血液水平较高、腹部超声检查发现胆囊周围有积液以及从腹腔镜手术转为开放手术被确定为影响死亡率的危险因素(P < 0.001、P = 0.001、P = 0.044、P = 0.005、P = 0.049、P = 0.009、P = 0.022、P = 0.011和P = 0.004)。入院前延迟时间较长和白细胞计数低被确定为影响死亡率的独立危险因素。

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