Adolph M D, Bass S N, Lee S K, Blum J M, Schreiber H
Department of Surgery, St. Luke's Medical Center, Cleveland, OH 44104.
Am Surg. 1993 Oct;59(10):679-84.
Abdominal pain and fever in patients with the acquired immunodeficiency syndrome (AIDS) may indicate cytomegaloviral (CMV) acalculous cholecystitis. We reviewed clinical, laboratory, and outcome data from 12 patients with CMV cholecystitis. Ten of 12 patients were homosexual males. Six patients had markedly low CD4: CD8 lymphocyte count ratios. Total leukocyte counts were normal or decreased, serum liver function tests normal or cholestatic, and only one patient had hyperbilirubinemia. Sonographic transmural gallbladder edema is typically more severe than expected for the presenting illness. Five of six patients investigated with HIDA scintigraphy had a nonvisualizing gallbladder. Open cholecystectomy had a 9.1 per cent operative morbidity and a 0 per cent mortality. Cholecystectomy is a safe and curative intervention, regardless of the immunocompromised condition of the host. Intraoperative cholangiography will identify papillary stenosis or sclerotic bile ducts as a potential cause of recurrent symptoms following surgery. A search for other sites of tissue invasion by CMV should follow cholecystectomy.
获得性免疫缺陷综合征（AIDS）患者出现腹痛和发热可能提示巨细胞病毒（CMV）非结石性胆囊炎。我们回顾了12例CMV胆囊炎患者的临床、实验室及转归数据。12例患者中有10例为同性恋男性。6例患者的CD4:CD8淋巴细胞计数比值显著降低。白细胞总数正常或降低，血清肝功能检查正常或呈胆汁淤积表现，仅有1例患者出现高胆红素血症。超声检查显示的胆囊壁透壁性水肿通常比当前疾病预期的更为严重。6例接受HIDA闪烁扫描检查的患者中有5例胆囊不显影。开腹胆囊切除术的手术发病率为9.1%，死亡率为0%。无论宿主免疫功能是否受损，胆囊切除术都是一种安全且可治愈的干预措施。术中胆管造影可发现乳头狭窄或硬化性胆管，这可能是术后复发症状的潜在原因。胆囊切除术后应查找CMV侵袭组织的其他部位。
