中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2009年
1期
17-19
,共3页
胆囊切除术%腹腔镜%内镜下逆行胰胆管造影%术后并发症%坏疽%外科手术
膽囊切除術%腹腔鏡%內鏡下逆行胰膽管造影%術後併髮癥%壞疽%外科手術
담낭절제술%복강경%내경하역행이담관조영%술후병발증%배저%외과수술
Cholecystectany,laparoscopic%Endoscopic retrograde cholangiopancreatography Postoperative complication%Gangrene%Surgery
目的 探讨EST+ERCP术后并发急性坏疽性胆囊炎(AGC)的外科诊治.方法 回顾性分析2005年12月至2007年6月浙江省杭州市第一人民医院收治的1468例行EST+ERCP手术病人的资料.结果 16例病人术后并发AGC,发生率为1.09%,主要表现为术后1～3 d突发右上腹疼痛伴局限性腹膜炎和发热.血白细胞总数>15.0×109/L 15例(93.8%).B超呈高张胆囊、双边影征改变等,术前诊断准确率为81.3%.该组行胆囊切除术10例,胆囊切除+胆总管切开取石+T管引流术2例,胆囊大部切除术3例,胆囊造瘘术1例,术后病理报告均为急性坏疽性胆囊炎.结论 术后1～3 d潜伏期、局限性腹膜炎、血白细胞升高及胆囊B超是EST+ERCP术后并发AGC诊断的主要依据,应与乳头区穿孔、重症胰腺炎等仔细鉴别,诊断明确后宜尽早手术.
目的 探討EST+ERCP術後併髮急性壞疽性膽囊炎(AGC)的外科診治.方法 迴顧性分析2005年12月至2007年6月浙江省杭州市第一人民醫院收治的1468例行EST+ERCP手術病人的資料.結果 16例病人術後併髮AGC,髮生率為1.09%,主要錶現為術後1～3 d突髮右上腹疼痛伴跼限性腹膜炎和髮熱.血白細胞總數>15.0×109/L 15例(93.8%).B超呈高張膽囊、雙邊影徵改變等,術前診斷準確率為81.3%.該組行膽囊切除術10例,膽囊切除+膽總管切開取石+T管引流術2例,膽囊大部切除術3例,膽囊造瘺術1例,術後病理報告均為急性壞疽性膽囊炎.結論 術後1～3 d潛伏期、跼限性腹膜炎、血白細胞升高及膽囊B超是EST+ERCP術後併髮AGC診斷的主要依據,應與乳頭區穿孔、重癥胰腺炎等仔細鑒彆,診斷明確後宜儘早手術.
목적 탐토EST+ERCP술후병발급성배저성담낭염(AGC)적외과진치.방법 회고성분석2005년12월지2007년6월절강성항주시제일인민의원수치적1468례행EST+ERCP수술병인적자료.결과 16례병인술후병발AGC,발생솔위1.09%,주요표현위술후1～3 d돌발우상복동통반국한성복막염화발열.혈백세포총수>15.0×109/L 15례(93.8%).B초정고장담낭、쌍변영정개변등,술전진단준학솔위81.3%.해조행담낭절제술10례,담낭절제+담총관절개취석+T관인류술2례,담낭대부절제술3례,담낭조루술1례,술후병리보고균위급성배저성담낭염.결론 술후1～3 d잠복기、국한성복막염、혈백세포승고급담낭B초시EST+ERCP술후병발AGC진단적주요의거,응여유두구천공、중증이선염등자세감별,진단명학후의진조수술.
Objective To discuss the diagnosis and surgical management of acute gangrenous cholecystitis (AGC) early after EST and ERCP. Methods Clinical and pathological data of 1468 cases receiving EST and ERCP in our hospital from 2005 to 2007 were retrospectively analyzed. Results AGC occurredin 16 cases and the incidence was 1.09%. Its main manifestations were pain in the right upper abdomen with local pertonitis and fever 1 to 3 d after operation, blood WBC exceeding 15.0× 109/L in 15 cases (93.8%), gallbladder tumefaction and double layer structure by B mode ultrasound, the diagnostic accuracy before operations was 81.3 %. We performed cholecystectomy in 10 cases, cholecystectomy and choledochotomy for common bile duct exploration and stone removal and T-tube drainage in 2, partial cholecystectomy in 3, cholecystostomy in 1. Pathological examination showedthat it was AGC in all the patients. Conclusion Latency in 1 to 3 d, local pertonitis, high blood WBC and B mode ultrasound are main managements in diagnosis of AGC and it should be diagnosed carefully distinguished from perforation and severe acute pencreatitis. It is suggested to undergoing early surgi-cal management once diagnosed definitely.
