Iarŭmov N, Penkov N, Viiachki I, Ivanov A, Kolarov E
Khirurgiia (Sofiia). 1994;47(6):14-7.
Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases. Diagnosis is made on the ground of active echographic and clinical observation. Conservative therapy is effective in 28 cases. The remainder (61) are operated at 1 to 4-day intervals after the onset of the disease because of persisting symptomatology and/or deterioration of the patient's condition. During laparotomy the gallbladder presents marked enlargement with thickened, exudate-imbibed wall. Cholecystectomy is done in all 61 cases. In twelve of them, owing to dilatation of the common bile duct and minimal serum bilirubin increase, stenosing papillitis is diagnosed by intraoperative cholangiography, treated by external biliary drainage and endoscopic sphincterotomy, undertaken after improvement of the general condition. Acute inflammation, free of fibrosis, with isolated foci of gangrene and necrosis of the bladder wall are histologically documented. In four senile patients presenting serious concomitant diseases, with exceptionally high operative risk, echographic percutaneous transhepatic cholecystectomy is resorted to, followed by antibiotic bladder instillations with a very good outcome. The summed up results of acute noncalculous cholecystitis treatment are estimated as very good.
基于全面的文献调研，分享了对89例急性非结石性胆囊炎患者的治疗经验。所有患者在疾病急性期均接受临床观察。其中60例表现为反复发作，29例既往无胆道疾病的体征或症状。通过积极的超声检查和临床观察进行诊断。28例患者采用保守治疗有效。其余61例因症状持续和/或病情恶化，在发病后1至4天内接受手术治疗。剖腹手术时，胆囊明显肿大，胆囊壁增厚且有渗出物浸润。61例均行胆囊切除术。其中12例因胆总管扩张且血清胆红素轻度升高，术中胆管造影诊断为乳头狭窄炎，在全身状况改善后，先行外引流，再行内镜括约肌切开术。组织学检查证实胆囊壁有急性炎症，无纤维化，有散在的坏疽和坏死灶。对于4例伴有严重合并症、手术风险极高的老年患者，采用超声引导下经皮经肝胆囊切除术，术后膀胱内注入抗生素，效果良好。急性非结石性胆囊炎的总体治疗效果评估为非常好。
