Gangrenous cholecystitis: Analysis of risk factors and experience with laparoscopic cholecystectomy
Gangrenous cholecystitis: Analysis of risk factors and experience with laparoscopic cholecystectomy
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DOI：
10.1067/msy.2099.99881
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发表时间：
1999-10-01
期刊：
影响因子：
3.8
通讯作者：
Joehl, RJ
中科院分区：
文献类型：
--
作者：
Merriam, LT;Kanaan, SA;Joehl, RJ
背景资料。坏疽胆囊炎发生在高达30%的急性胆囊炎住院患者中。预测急性胆囊炎患者坏疽疾病的因素仍然不明确，这使得术前诊断变得困难。明确这些因素，早期诊断坏疽胆囊炎，将提示更积极的治疗，更早的手术，以及较低的腹腔镜中转开腹手术门槛。我们回顾了1995-1996两年间我们治疗急性胆囊炎的经验。对每个患者的入院病史、体格检查、手术报告、实验室和放射学资料以及病理报告进行分析。肉眼和显微镜检查均诊断为急性胆囊炎及其坏疽并发症。154例急性胆囊炎患者入院接受了胆囊切除术，其中27例(18%)发生了胆囊性坏疽。4例行开腹胆囊切除术，23例行腹腔镜手术，其中15例(65%)在腹腔镜下完成，8例(35%)因严重炎症中转开腹。发生胆囊性坏疽的危险因素包括男性、年龄>50岁、心血管病史、白细胞计数>17000个/毫升。老年男性患者(年龄>50岁)有心血管病史、白细胞计数>17,000个/毫升、急性胆囊炎患者发生胆囊性坏疽的风险增加，在这些有胆囊性坏疽的高危患者中，应考虑中转开腹、中转开腹的低门槛的胆囊切除术。
Background. Gangrenous cholecystitis occurs in up to 30% of patients admitted with acute cholecystitis. Factors predicting gangrenous disease in patients with acute cholecystitis remain poorly defined, making preoperative diagnosis difficult. Identification of these factors and early diagnosis of gangrenous cholecystitis will indicate more aggressive treatment, earlier operation, and a lower threshold for conversion of laparoscopic to open cholecystectomy.Methods. We reviewed our experience with acute cholecystitis during the 2-year period of 1995 to 1996. Admitting history, physical examination, operative report, laboratory and radiology data, and pathology report were analyzed for each patient. Acute cholecystitis and its gangrenous complication were diagnosed by both gross and microscopic examination.Results. One hundred fifty-four patients were admitted to the hospital with acute cholecystitis and underwent cholecystectomy; gallbladder gangrene was found in 27 (18%) of these patients. Four patients with gallbladder gangrene underwent open cholecystectomy and 23 patients underwent laparoscopic cholecystectomy, of which 15 (65%) were completed laparoscopically and 8 (35%) had open conversion as a result of severe inflammation. Risk factors for gallbladder gangrene included male gender, age older than 50 years, history of cardiovascular disease, and leukocytosis greater than 17,000 white blood cells/mL.Conclusions. Older male patients (age older than 50 years) with history of cardiovascular disease, leukocytosis greater than 17,000 white blood cells/mL, and acute cholecystitis have increased risk of gallbladder gangrene and conversion of laparoscopic cholecystectomy to open cholecystectomy should be considered in these cholecystectomy with low threshold for conversion to open cholecystectomy should be considered in these patients at high risk for gallbladder gangrene.