Brandt C P, Priebe P P, Jacobs D G
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109.
Surg Endosc. 1994 May;8(5):361-4; discussion 364-5. doi: 10.1007/BF00642431.
Patients who require prolonged intensive care following traumatic injuries are at risk for developing acute acalculous cholecystitis (AAC). The diagnosis of AAC is often difficult to establish, resulting in increased morbidity and mortality in this critically ill population. We reasoned that diagnostic laparoscopy might provide a more accurate and timely method of diagnosis. Laparoscopy was performed in nine trauma ICU patients with suspected AAC. Four procedures were considered positive and five were negative. There were no false-positive or false-negative laparoscopic exams, and no procedure-related morbidity occurred. Comparison of multiple clinical, laboratory, and radiologic findings showed that only laparoscopy accurately distinguished between those patients with AAC and those without AAC. We conclude that diagnostic laparoscopy is safe and definitive in trauma ICU patients with suspected AAC and should be performed prior to proceeding with laparotomy.
遭受创伤性损伤后需要长期重症监护的患者有发生急性非结石性胆囊炎（AAC）的风险。AAC的诊断往往很难确立，这导致该危重症人群的发病率和死亡率增加。我们推断诊断性腹腔镜检查可能提供一种更准确、及时的诊断方法。对9例疑似AAC的创伤重症监护病房患者进行了腹腔镜检查。4例检查结果为阳性，5例为阴性。腹腔镜检查没有假阳性或假阴性结果，也未发生与检查相关的并发症。对多项临床、实验室和影像学检查结果进行比较发现，只有腹腔镜检查能准确区分患有AAC和未患AAC的患者。我们得出结论，对于疑似AAC的创伤重症监护病房患者，诊断性腹腔镜检查是安全且明确的，应在开腹手术前进行。
