Grinev M V, Ryss A Iu
Vestn Khir Im I I Grek. 1989 Jul;143(7):3-7.
An investigation of specific course of the disease in 911 patients operated upon for acute cholecystitis with bilirubinemia has shown that mechanical jaundice resulting from choledocholithiasis takes place in a third of the patients. Obstruction of the bile duct was confirmed in 27.1% of the patients during cholangiography. Prevalence of a number of factors was noted indicating of a toxic lesion of the liver (destructive forms of acute cholecystitis in 81.0% of the patients, higher level of bilirubinemia in long terms of the disease, the presence of coexistent pancreatitis in 30.5%, cholangitis--in 39.3%). An investigation of 207 bioptates of the liver in acute cholecystitis has revealed fatty degeneration of hepatocytes in 56.5%, pericholangitis--in 43.0%, cholestasis--in 21.3% of the cases. The cause of jaundice in acute cholecystitis mainly is an alteration of the hepatic cells due to pyo-resorptive intoxication manifested as cholestasis and hepatitis.
对911例因急性胆囊炎伴胆红素血症接受手术治疗的患者的疾病具体病程进行调查显示，三分之一的患者发生了由胆总管结石引起的机械性黄疸。在胆管造影检查中，27.1%的患者证实存在胆管梗阻。注意到一些因素的普遍性，提示肝脏存在毒性损害（81.0%的患者为急性胆囊炎的破坏性形式，病程较长时胆红素血症水平较高，30.发现急性胆囊炎患者的207份肝活检标本中，56.5%的病例出现肝细胞脂肪变性，43.0%出现胆管周围炎，21.3%出现胆汁淤积。急性胆囊炎黄疸的主要原因是脓性吸收性中毒导致肝细胞改变，表现为胆汁淤积和肝炎。 5%的患者存在并存胰腺炎，39.3%存在胆管炎）。
