ICU老年急性非结石性胆囊炎诊治临床分析

Clinical Analysis of Diagnosis and Treatment of Acute Acalculous Cholecystitis in Elderly Patients in the ICU

目的:探讨ICU老年急性非结石性胆囊炎的病因、发病机制、早期诊断及治疗方法。方法:回顾性分析2013年7月-2019年7月笔者所在医院收治的14例老年急性非结石性胆囊炎患者的临床资料,统计所有患者的主要原发疾病、临床表现、实验室检查、影像学检查、治疗方法及治疗效果。结果:老年急性非结石性胆囊炎多见于由严重创伤、腹部大手术后及感染等因素所致的强烈应激状态下的患者,发病与胆汁淤积、胆囊血运障碍及感染密切相关,B超检查结合临床症状、体征及相关实验室检查可诊断。14例患者中,行经皮经肝胆囊穿刺引流术(PTGBD)8例,行腹腔镜胆囊切除术(LC)4例,行保守治疗2例;除2例放弃治疗及1例因原发疾病加重死亡外,余11例恢复良好。结论:ICU老年急性非结石性胆囊炎易被误诊、漏诊,其发病急,进展快,易出现坏疽、穿孔,及时运用床旁超声进行早期诊断,合理选择治疗方式,特别是PTGBD,可取得满意效果。

Objective:To investigate the etiology,pathogenesis,early diagnosis and treatment of elderly patients with acute acalculous cholecystitis in the ICU.Method:The clinical data of 14 elderly patients with acute acalculous cholecystitis treated in our hospital from July 2013 to July 2019 were retrospectively analyzed.The primary diseases,the clinical manifestations,the laboratory tests,the imaging tests,the treatment methods and the treatment effects of all patients were used for analysis.Result:Acute acalculous cholecystitis was arisen in elderly patients under strong stress caused by severe trauma,undergoing major abdominal surgery and infection.It was closely related to cholestasis,gallbladder with blood supply deficiency and infection.B-ultrasonic examination combined with clinical symptoms,signs and related laboratory tests can be diagnosed.Among the 14 cases,there were 8 cases underwent percutaneous transhepatic gallbladder drainage(PTGBD),and 4 cases underwent laparoscopic cholecystectomy(LC),and 2 cases underwent conservative treatment.And 11 cases recovered well except 2 cases of giving up treatment and 1 case of death due to aggravation of primary disease.Conclusion:Elderly patients with acute acalculous cholecystitis in the ICU is easy to be misdiagnosed and missed.It has a rapid onset,rapid progress,and prone to gallbladder gangrene and perforation.Timely use of bedside ultrasound for early diagnosis and reasonable choice of treatment,especially the operative type of PTGBD,can achieve satisfactory curative effect.