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目的探讨重症患者继发急性胆囊炎者的合理手术治疗方案。方法以损伤控制性手术理论为指导,对许昌市中心医院2008年10月-2012年4月收治的通过手术治疗成功,随访存活超过6个月的8例不同类型重症患者继发急性胆囊炎者的临床资料进行回顾性分析,并以此总结最合理手术方案。结果 8例患者均采取在急诊局麻下采取胆囊造瘘术,术后最快12 h症状即明显缓解,术后3～5 d体温及白细胞计数逐步恢复,术后均痊愈出院,平均住院时间为28 d(16～45 d)。8例患者于术后3个月均择期成功施行腹腔镜胆囊切除术。随访时间6个月～3年。结论遵循损伤控制性手术理念,重症患者继发急性胆囊炎者经保守治疗无效时的合理手术方案为一期单纯胆囊造瘘术,并于术后3月择期完成二期腹腔镜胆囊切除术。
Objective To investigate the rational surgical treatment of acute cholecystitis in critically ill patients. Methods Based on the theory of injury control surgery, eight patients with acute cholecystitis in eight different types of severe patients who survived more than 6 months after surgery were successfully treated in Xuchang Central Hospital from October 2008 to April 2012 The clinical data of retrospective analysis, and in order to summarize the most reasonable surgical options. Results All the 8 patients were taken cholecystectomy under emergency local anesthesia. The symptom was relieved as soon as 12 h after operation. The body temperature and white blood cell count recovered gradually after 3 ~ 5 d after operation. All the patients were recovered and discharged after operation. The average hospital stay For 28 days (16 ~ 45 days). All patients underwent laparoscopic cholecystectomy successfully in 3 months after operation. Follow-up time of 6 months to 3 years. Conclusions Following the concept of injury-controlled surgery, a reasonable surgical protocol for patients with acute cholecystitis secondary to severe acute cholecystitis after conservative treatment is a simple cholecystostomy. Elective laparoscopic cholecystectomy was performed in March after elective laparoscopic cholecystectomy.