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目的探讨急性非结石性胆囊炎(acute acalculous cholecystitis,AAC)的临床特点与治疗方法。方法回顾性分析我院2000～2008年收治的21例急性非结石性胆囊炎的临床资料。结果本组病例占同期急性胆囊炎病例的11.29%(21/186),均并存有不同程度的系统性疾病,心血管病有高血压、冠心病、心律失常42.9%(9/21);肝脏疾病有脂肪肝、慢性肝炎33.3%(7/21);胆道疾病有胆囊息肉、胆道蛔虫14.3%(3/21);糖尿病23.8%(5/21)。两个系统同时有病者3例。18例行早期胆囊切除术,3例作胆囊造瘘术,其中7例胆囊坏死、穿孔(33.3%),均获得痊愈。术后并发症8例包括切口感染、切口裂开、腹腔感染、肺部感染、应激性溃疡等。21例患者无1例死亡。结论本病进展快,胆囊坏疽、穿孔比例高,术后并发症多,一旦诊断,应积极手术治疗。
Objective To investigate the clinical features and treatment of acute acalculous cholecystitis (AAC). Methods The clinical data of 21 patients with acute acalculous cholecystitis admitted from 2000 to 2008 in our hospital were retrospectively analyzed. Results The patients in this group accounted for 11.29% (21/186) of the patients with acute cholecystitis in the same period. All of them had various degrees of systemic diseases. Cardiovascular diseases included hypertension, coronary heart disease and arrhythmia (42.9%, 9/21) Fatty liver disease, chronic hepatitis 33.3% (7/21); biliary tract disease gallbladder polyps, biliary Ascaris 14.3% (3/21); diabetes mellitus 23.8% (5/21). Two systems were sick at the same time in 3 cases. 18 cases of early cholecystectomy, 3 cases of cholecystectomy, including 7 cases of gallbladder necrosis, perforation (33.3%), were cured. Postoperative complications in 8 cases include incision infection, incision split, abdominal infection, lung infection, stress ulcer and so on. None of the 21 patients died. Conclusion The disease progresses rapidly, gallbladder gangrene, high perforation rate, postoperative complications, once diagnosed, should be actively treated.