非结石性慢性胆囊炎:临床转归、诊断与治疗

Outcome, diagnosis and treatment of chronic acalulous cholecystitis

目的探讨非结石性慢性胆囊炎的临床转归、诊断与治疗问题。方法院外诊断“非结石性慢性胆囊炎”1752例,除外误诊1569例,确诊慢性胆囊炎183例,确诊后即手术16例,非手术治疗并定期随访1～8年167例。结果167例失访24例,6例治疗后无症状出现,137例症状反复,其中21例发生胆囊结石或(和)胆囊胆固醇息肉,5例症状发作频繁最终接受手术治疗。结论非结石性慢性胆囊炎误诊误治情况较普遍,应该引起临床医师高度重视;胆囊功能测定,有助于降低误诊率。约18%的非结石性慢性胆囊炎病人,可能发生胆囊息肉或胆囊结石,或症状频繁需手术治疗。胆囊周围粘连是胆囊排空障碍的原因之一,松解粘连,而不切除胆囊的处理方式,值得探讨。

Objective To discuss some problems of the outcome, diagnosis and treatment of chronic acalculous cholecystitis. Methods For 1752 cases diagnosed in other hospitals as chronic acalculous cholecystitis, 183 were confirmed and 1569 were excluded by us. Of the 183 confirmed cases, 16 received operation at onset and 167 were followed up for 1-8 years. Results Twenty-four of the 167 cases missed during the follow-up period. For the other 143 patients, 6 were cured and 137 had recurrent symptoms. Amongst these 137 patients, 21 had gallstone and/or gallbladder polypus and 5 of them who had frequent episodes of biliary colic received operation. Conclusions It is common that chronic acalculous cholecystitis is misdiagnosed and not correctly treated, which should be paid more attention to. It’s useful to calculate gallbladder ejection fraction by abdominal ultrasonography to decrease the rate of misdiagnosis. Eighteen percent of the patients with chronic acalculous cholecystitis have gallstone and/or gallbladder polypus, or have to receive an operation for frequent episodes of pain. Loosing adhesions but not rnemoving gallbladder for treatment of chronic acalculous cholecystitis should be further evaluated since adhesions near the gallbladder is a factor causing gallbladder dysfunction.