中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (01): 76-79.

• 论著 • 上一篇    下一篇

坏疽性胆囊炎——重症急性胰腺炎的严重并发症之一

黄    洁，秦    帅，毛恩强，汤耀卿，张圣道   

  1. 上海交通大学医学院附属瑞金医院ICU，上海 200025
  • 出版日期:2011-01-01 发布日期:2011-05-30

  • Online:2011-01-01 Published:2011-05-30

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摘要：

目的    探讨重症急性胰腺炎（SAP）并发坏疽性胆囊炎的临床特点，为早期诊断和外科处理提供依据。方法    回顾2008年1月至2009年12月上海交通大学医学院附属瑞金医院外科ICU收治的4例SAP并发坏疽性胆囊炎的病历资料，分析其发病因素、临床表现、外科处理及预后。结果    4例病人均伴有严重腹腔内感染、感染性休克及多器官功能障碍综合征（MODS）；体征主要表现为程度不同的意识障碍，但腹部体征无特异性；肝脏转氨酶和黄疸指数仅轻度异常；CT检查有明显的胆囊增大、囊壁增厚及囊内结石，胆囊与肝脏的分界模糊甚至囊壁缺失。均未及时外科处理胆道。手术指征主要是根据病人难以控制的全身感染、脏器功能损害和意识障碍加重。1例经手术切除坏疽胆囊后治愈，另3例行胆囊引流，疗效差，2例死亡。结论    SAP急性反应期内尽早识别坏疽性胆囊炎并积极手术切除胆囊，有助于改善预后。

关键词: 重症急性胰腺炎, 坏疽性胆囊炎

Abstract:

Gangrenous cholecystitis - the lethal complication of severe acute pancreatitis(SAP)        HUANG Jie, QIN Shuai, MAO En-qiang, et al. Department of ICU, Ruijin Hospital, School of Medcine, Shanghai Jiaotong University, Shanghai 200025, China.
Corresponding author: MAO En-qiang, E-mail:maoeq@yeah.net.
Abstract    Objective    Study for the characteristics of gangrenous cholecystitis in patients with SAP to support future clinical diagnosis and treatment. Methods    Retrospectively analyze the predisposing factors, clinical characteristics, surgical intervention and prognosis of 4 gangrenous cholecystitis with SAP patients admitted in our ICU between Jan 2008 and Dec 2009. Results    4 SAP patients presented gangrenous cholecystitis with a morbidity of 5.9%. These patients presented severe sepsis, septic shock and organ dysfunction with aminotransferase and bilirubin little elevated. CT imaging showed gallbladder engorgement, wall thickening, gallstone, irregular or absent wall. Surgical interventions were performed until those patients presented severe sepsis, organic dysfunction and severe encephalopathy. One patient achieved a favorable clinical response after cholecystectomy, Clinical failure was observed in other 3 patients after gallbladder drainage, and overall end-of-treatment mortality was 2/4. Conclution    Early diagnosis and surgical intervention of gangrenous cholecystitis in the acute phase reaction of SAP was important and helpful to improve prognosis.