Ludwig L L, McLoughlin M A, Graves T K, Crisp M S
Department of Veterinary Clinical Sciences and Small Animal Surgery, College of Veterinary Medicine, Ohio State University, Columbus, USA.
Vet Surg. 1997 Mar-Apr;26(2):90-8. doi: 10.1111/j.1532-950x.1997.tb01470.x.
The purpose of this study was to determine the signalment, history, clinical signs, diagnosis, treatment, outcome, and factors affecting outcome of dogs and cats surgically treated for bile peritonitis.
Retrospective study.
Twenty-four dogs and two cats surgically treated for bile peritonitis.
The medical records of dogs and cats surgically treated for biliary effusions at the Ohio State University and Michigan State University between 1987 and 1994 were reviewed. Statistical analysis was performed to compare factors affecting outcome.
The cause of the biliary effusion was determined in 24 animals, and resulted from disruption of the biliary tract secondary to trauma (n = 13) or necrotizing cholecystitis (n = 11). Determination of the bilirubin concentration of the abdominal effusion was the only diagnostic test that was 100% effective in diagnosing bile leakage before surgical intervention. The bilirubin concentration of the effusion was consistently at least two times higher than the serum bilirubin concentration. Bacteriologic culture and sensitivity revealed that a septic, biliary effusion was usually associated with multiple types of gram-negative bacteria. The overall survival rate was 50% (13 of 26). The peripheral white blood cell count was significantly lower in survivors (mean 20,608/uL) compared with nonsurvivors (mean 35,712/uL). The immature neutrophil count was also significantly lower in survivors (mean 686/uL) than in nonsurvivors (4,852/uL). Only 27% (3 of 11) of the animals with a septic biliary effusion survived. In contrast, 100% (6 of 6) of the animals in which no bacteria were isolated from the abdominal effusion survived. Open abdominal drainage was not a successful treatment for 7 of 9 animals with septic biliary effusions. Survival was not significantly affected by the distribution of the peritonitis, cause of biliary effusion, or duration of clinical signs before surgical intervention.
Patients with sterile biliary effusions have a much lower mortality rate than those with septic biliary effusions. The successful treatment of sterile biliary effusions does not require open abdominal drainage, and is not affected by the duration of the effusion.
This retrospective study provides information that may aid the surgeon in the diagnosis and treatment of bile peritonitis.
本研究的目的是确定接受手术治疗胆汁性腹膜炎的犬猫的体征、病史、临床症状、诊断、治疗、预后以及影响预后的因素。
回顾性研究。
24只犬和2只猫接受了手术治疗胆汁性腹膜炎。
回顾了1987年至1994年期间在俄亥俄州立大学和密歇根州立大学接受手术治疗胆漏的犬猫的病历。进行统计分析以比较影响预后的因素。
确定了24只动物胆漏的原因，其原因是继发于创伤（n = 13）或坏死性胆囊炎（n = 11）的胆道破裂。测定腹腔积液中的胆红素浓度是手术干预前诊断胆汁漏唯一100%有效的诊断测试。积液中的胆红素浓度始终至少比血清胆红素浓度高两倍。细菌培养和药敏试验表明，感染性胆漏通常与多种革兰氏阴性菌有关。总体存活率为50%（26只中的13只）。与未存活者（平均35,712/μL）相比，存活者的外周白细胞计数显著更低（平均20,608/μL）。存活者的未成熟中性粒细胞计数也显著低于未存活者（平均686/μL比4,852/μL）。感染性胆漏的动物中只有27%（11只中的3只）存活。相比之下，腹腔积液中未分离出细菌的动物100%（6只中的六只）存活。对于9只感染性胆漏动物中的7只，开放腹腔引流不是一种成功的治疗方法。腹膜炎的分布、胆漏的原因或手术干预前临床症状的持续时间对存活没有显著影响。
无菌性胆漏患者的死亡率远低于感染性胆漏患者。无菌性胆漏的成功治疗不需要开放腹腔引流，且不受胆漏持续时间的影响。
这项回顾性研究提供的信息可能有助于外科医生对胆汁性腹膜炎的诊断和治疗。
