急性胆囊炎诊治策略

Strategies for the Diagnosis and Management of Acute Cholecystitis

急性胆囊炎(ACC)属于常见急腹症,其发病率占所有急腹症的3%~10%,结石性胆囊炎的患者在其中占比最高,其余为非结石性胆囊炎。近年来我国急性胆囊炎发病率不断地上升,流行病学研究表明,10%~15%的人患有胆管结石,其中每年有1%~3%的人患急性胆囊炎或急性胆管炎。如果不正规治疗,感染会恶化,导致感染性休克、多系统器官功能衰竭(MODS)或脓毒血症。因此,规范急性胆囊炎的诊断和治疗,减少急性胆囊炎手术中胆道损伤等严重并发症事件的发生,具有非常重要的意义。2018年,日本肝胆胰腺外科学会发表了急性胆囊炎的管理流程指南(2018东京指南)。2020年,世界急诊外科学会(WSES)更新发表了急性结石性胆囊炎的诊断和管理指南。2021年,中华医学会(CMA)外科学分会胆道外科学组在中华外科杂志发布了《急性胆道系统感染的诊断和治疗指南》。本文主要根据这三个指南总结急性胆囊炎的诊疗策略。

Acute cholecystitis (ACC) is a common acute abdominal condition, and its incidence accounts for 3%~10% of all acute abdominal conditions, with stone cholecystitis accounting for the highest pro-portion of patients, and non-stone cholecystitis accounting for the rest. In recent years, the inci-dence of acute cholecystitis has been increasing in China. Epidemiologic studies have shown that 10%~15% of the population suffers from bile duct stones, of which 1%~3% suffer from acute cholecystitis or acute cholangitis every year. Without formal treatment, the infection can worsen, leading to infectious shock, multisystem organ failure (MODS), or sepsis. Therefore, it is of great importance to standardize the diagnosis and treatment of acute cholecystitis and to reduce the in-cidence of serious complication events, such as biliary tract injuries during surgery for acute cholecystitis. In 2018, the Japanese Society of Hepatobiliary and Pancreatic Surgery published a guideline on the process of management of acute cholecystitis (the 2018 Tokyo Guidelines). In 2020, the World Society of Emergency Surgery (WSES) updated and published an acute calculous cholecystitis Diagnosis and Management Guidelines. In 2021, the Biliary Surgery Group of the Chinese Medical Association (CMA) Surgery Branch published the Guidelines for the Diagnosis and Treatment of Acute Biliary Systemic Infections in the Chinese Journal of Surgery. This article summarizes the diagnostic and management strategies for acute cholecystitis based on these three guidelines.