以胆囊排空障碍为特点的慢性非结石性胆囊炎的诊治分析：附42例

Diagnosis and surgical treatment of chronic acaiculous cholecystitis characterized by absence of gallbladder wall contractability in 42 cases

目的探讨以胆囊排空障碍为特点的慢性非结石性胆囊炎的诊断方法与外科治疗。方法选取昆明医学院第二附属医院2006年1月至2008年12月收治的慢性非结石性胆囊炎42例临床资料进行分析。将其分为腹腔镜胆囊切除术组20例，非手术治疗组22例，比较其疗效。结果42例均通过临床症状、B超、胆囊收缩功能检查、纤维胃镜、磁共振胰胆管成像得以诊断；均存在胆囊排空障碍，其中腹腔镜胆囊切除术组，术后随访18例，未再出现临床症状，失访2例；非手术治疗组，随访21例，临床症状反复发作19例，失访1例。腹腔镜胆囊切除术效果明显优于非手术治疗（P〈0．05）。结论以胆囊排空障碍为特点的慢性非结石胆囊炎可以通过临床症状、胆囊收缩功能检查、MRCP得以诊断，治疗方法以腹腔镜胆囊切除术为佳。

Objective To investigate the diagnosis and surgical treatment of chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability. Methods The clinical data of 42 patients with chronic acalculous cholecystitis in our hospital from January 2006 to December 2008 were analysed. The patients were grouped into two groups： laparoscopic cholecystectomy （LC） group in 20 and non-surgical group in 22. The patients＇ symptoms on follow-up in the two groups were com- pared. Results The 42 patients with chronic acalculous cholecystitis were diagnosed by symptoms, ultrasound, fatty meal gallbladder contractability studies under ultrasound, fiber optic gastroscopy and magnetic resonance cholangiopancreatography （MRCP）. In all patients, there was a complete absence of gallbladder wall contractability. In the LC groups, 20 patients received LC. 18 patients were followed up, and there were no symptoms. Two patients were lost to follow up. In the non-surgical group, 22 patients received non-surgical treatment. In 21 patients who were followed up, 19 patients had symptoms. One patient was lost to follow up. There was a significant difference between the LC group and the non-surgical group （P〈0.05）. Conclusions Chronic acalculous cholecystitis characterized by absence of gallbladder wall contractability could be diagnosed by symptoms, ultrasound, fatty meal gallbladder contractability studies under untrasound, and MRCP. The optimal treatment of chro nic acalculous cholecystitis characterized by absence of gallbladder wall contractability is LC.