Mount Sinai Department of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 15th floor, New York, NY, 10029, USA.
J Gastrointest Surg. 2019 Aug;23(8):1589-1592. doi: 10.1007/s11605-018-04077-w. Epub 2019 Jan 11.
Acute cholecystitis is a life-threatening disease process in immunocompromised patients. The purpose of this study is to determine the incidence, clinical course, and management of calculous and acalculous acute cholecystitis in immunocompromised patients.
A single center's database was queried for all patients with a diagnosis of acute cholecystitis from January 1, 2003 to September 30, 2016 with concomitant diagnosis of neutropenia, leukopenia, leukemia, or lymphoma. These cases subsequently underwent chart review. Data on demographics, diagnostic studies, and management were collected and analyzed.
There were 4525 patients diagnosed with acute cholecystitis during the study window. One hundred twenty patients were identified to be immunocompromised at time of diagnosis. Seventy-nine patients (65.8%) had acute calculous cholecystitis while 41 patients (34.2%) had acalculous cholecystitis. There were no significant demographic differences between calculous and acalculous groups. There was similar use of percutaneous cholecystostomy tube (7.6%, 9.8%, p = 0.69), laparoscopic cholecystectomy (70.9%, 61.0%, p = 0.27), and open cholecystectomy (10.3%, 2.4%, p = 0.13) in both calculous and acalculous groups.
While immunosuppression is commonly thought to be associated with acalculous cholecystitis, our data suggest the majority of acute cholecystitis in immunocompromised patients are calculous. Most patients in our studies were managed successfully with laparoscopic cholecystectomy with acceptably low complication rates.
Calculous cholecystitis is more common than acalculous cholecystitis in immunocompromised patients. Both are often managed successfully with laparoscopic cholecystectomy with very low rates of conversion to open cholecystectomy.
急性胆囊炎是免疫功能低下患者危及生命的疾病过程。本研究的目的是确定免疫功能低下患者中结石性和非结石性急性胆囊炎的发病率、临床过程和治疗方法。
对 2003 年 1 月 1 日至 2016 年 9 月 30 日期间因中性粒细胞减少症、白细胞减少症、白血病或淋巴瘤同时诊断为急性胆囊炎的所有患者的单个中心数据库进行了查询。随后对这些病例进行了图表审查。收集并分析了人口统计学、诊断研究和治疗管理的数据。
在研究期间，共有 4525 例患者被诊断为急性胆囊炎。在诊断时，有 120 例患者被确定为免疫功能低下。79 例（65.8%）为急性结石性胆囊炎，41 例（34.2%）为非结石性胆囊炎。结石性和非结石性组之间没有明显的人口统计学差异。经皮胆囊造瘘管（7.6%，9.8%，p=0.69）、腹腔镜胆囊切除术（70.9%，61.0%，p=0.27）和开腹胆囊切除术（10.3%，2.4%，p=0.13）的使用率相似。
虽然人们普遍认为免疫抑制与非结石性胆囊炎有关，但我们的数据表明，免疫功能低下患者的大多数急性胆囊炎为结石性。我们研究中的大多数患者都成功地接受了腹腔镜胆囊切除术治疗，并发症发生率可接受。
在免疫功能低下的患者中，结石性胆囊炎比非结石性胆囊炎更为常见。两者通常都可以通过腹腔镜胆囊切除术成功治疗，且中转开腹的比例非常低。
