Hagino R T, Valentine R J, Clagett G P
Department of Surgery, University of Texas Southwestern Medical School, Dallas, USA.
J Am Coll Surg. 1997 Mar;184(3):245-8.
Acute acalculous cholecystitis is rare in patients undergoing aortic surgery; but, this condition is associated with a high mortality rate. With their comorbid medical problems, patients undergoing aortic reconstruction may have a higher mortality associated with acute acalculous cholecystitis.
By retrospectively reviewing patient charts, we studied the prevalence, demographics, details of antecedant aortic procedures, hospital course, and outcome of patients with acute acalculous cholecystitis after aortic surgery.
In the past 10 years, 7 of the 996 patients who underwent aortic reconstruction at our institution developed postoperative acute acalculous cholecystitis. These patients were all nondiabetic men with a mean age of 66 +/- 4 years (range, 50 to 76 years). Previous aortic operations included four infrarenal aneurysmorrhaphies (three elective, one urgent for a ruptured aneurysm), two aortofemoral bypasses for occlusive disease, and a removal of an infected aortic prosthesis. Six patients had prolonged intraoperative hypotension and increased blood transfusion requirements. All patients had postoperative multiorgan dysfunction. The patients developed fever, leukocytosis, elevated liver function test levels, and other signs and symptoms of acute acalculous cholecystitis a mean of 32 days (range, 9 to 90 days) after operation. Preoperative diagnosis was made in five patients based on clinical examination, laboratory test results, and adjunctive noninvasive test results. Two patients required laparotomy to make the diagnosis of acute acalculous cholecystitis. Five patients underwent cholecystectomy, and two had placement of cholecystostomy tubes. Gangrene or perforation was evident in most. Overall mortality was 71 percent.
Acute acalculous cholecystitis is the most common postoperative biliary complication after aortic surgery. The diagnosis should be entertained in patients with signs of abdominal sepsis after aortic surgery, especially those with a complicated postoperative course. Even if acute acalculous cholecystitis is diagnosed before exploration, mortality remains high.
急性非结石性胆囊炎在接受主动脉手术的患者中较为罕见；但这种情况与高死亡率相关。由于合并有其他内科问题，接受主动脉重建手术的患者因急性非结石性胆囊炎可能有更高的死亡率。
通过回顾性查阅患者病历，我们研究了主动脉手术后急性非结石性胆囊炎患者的患病率、人口统计学特征、先前主动脉手术的详细情况、住院病程及预后。
在过去10年中，我们机构996例接受主动脉重建手术的患者中有7例发生了术后急性非结石性胆囊炎。这些患者均为非糖尿病男性，平均年龄66±4岁（范围50至76岁）。先前的主动脉手术包括4例肾下腹主动脉瘤修补术（3例择期，1例因动脉瘤破裂急诊）、2例因闭塞性疾病行主动脉股动脉旁路移植术以及1例感染性主动脉人工血管移除术。6例患者术中出现长时间低血压且输血需求增加。所有患者术后均出现多器官功能障碍。患者在术后平均32天（范围9至90天）出现发热、白细胞增多、肝功能检查水平升高及其他急性非结石性胆囊炎的体征和症状。5例患者根据临床检查、实验室检查结果及辅助性非侵入性检查结果在术前得以诊断。2例患者需行剖腹手术才能诊断为急性非结石性胆囊炎。5例患者接受了胆囊切除术，2例患者置入了胆囊造瘘管。多数患者有坏疽或穿孔。总体死亡率为71%。
急性非结石性胆囊炎是主动脉手术后最常见的术后胆道并发症。对于主动脉手术后出现腹部感染迹象的患者，尤其是术后病程复杂的患者，应考虑该诊断。即使在探查前诊断出急性非结石性胆囊炎，死亡率仍然很高。
