中国实用外科杂志

中国实用外科杂志

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重症急性胰腺炎并发急性非结石性胆囊炎39例诊治分析

贾成朋，李国庆，徐西伯，贾    勇，李轶龙，李    乐，王拥卫，陈    华，孙    备   

  1. 哈尔滨医科大学附属第一医院胰胆外科  肝脾外科教育部重点实验室，黑龙江哈尔滨  150001 
  • 出版日期:2019-10-01 发布日期:2019-10-10

  • Online:2019-10-01 Published:2019-10-10

摘要：

目的    总结重症急性胰腺炎（SAP）并发急性非结石性胆囊炎（AAC）的诊治经验。方法    回顾性分析2012年9月至2017年8月哈尔滨医科大学附属第一医院胰胆外科收治的141例SAP病人的临床资料，其中39例SAP并发AAC，分析SAP并发AAC的临床特点及诊疗要点，并与未合并AAC的病人基本资料及治疗情况进行对比。结果    SAP并发AAC的发生率为27.7%（39/141)。与未合并AAC病人比较，SAP合并AAC病人在年龄［（48.8±12.5）岁 vs. （41.4±10.9）岁］、Balthazar CTSI评分［（6.8±1.3）分 vs. （5.7±1.3）分］、既往合并糖尿病（35.9% vs. 18.6%）、禁食时间［（16.9±9.5）h vs. （12.2±7.6）h］、急性呼吸窘迫综合征发生率（74.3% vs. 54.9%）及急性肾衰竭发生率（43.6% vs. 23.5%）、住院时间［（33.7±19.6）d vs. （21.9±12.9）d］差异具有统计学意义（P<0.05）。合并AAC病人中，8例行保守治疗，31例因胆囊炎症较重而行有创治疗，其中20例行经皮经肝胆囊穿刺置管引流术（PTGD）后病情好转。随访3.5（1~8）个月，SAP合并AAC病人的病死率高于同期未并发AAC者，但差异无统计学意义（20.5% vs. 8.8%，P=0.106）。结论    AAC是SAP病程后期常见并发症之一，应引起高度重视；早期诊断及个体化治疗是延缓病程进展及提高疗效的关键；对于此类病人，PTGD是一种安全、有效的治疗方法，值得推广。

关键词: 重症急性胰腺炎, 急性非结石性胆囊炎, 经皮经肝胆囊穿刺置管引流术

Abstract:

Clinical analysis of severe acute pancreatitis complicated with acute acalculous cholecystitis：a 39 cases report             JIA Cheng-peng，LI Guo-qing，XU Xi-bo，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital of Harbin Medical University & Key Laboratory of Hepatosplenic Surgery ，Ministry of Education，Harbin 150001，China
Corresponding author：CHEN Hua，E-mail：chenhuahyd@126.com
Abstract    Objective    To summarize the clinical characteristics of severe acute pancreatitis （SAP）complicated with acute acalculous cholecystitis（AAC）. Methods    The clinical data of 141 SAP patients admitted in the First Affiliated Hospital of Harbin Medical University from September 2012 to August 2017 were analyzed retrospectively. Among them, 39 SAP patients were complicated with AAC. The clinical characteristics and key points of diagnosis and treatment of SAP complicated with AAC were analyzed and compared with the basic data and treatment of patients without AAC. Results    The incidence of SAP complicated with AAC was 27.7%（39/141）. Compared with the non-AAC group，the AAC group had statistically significant differences in age [（48.8±12.5）years vs. （41.4±10.9）years], Balthazar CTSI score [（6.8±1.3） vs. （5.7±1.3）]，diabetes mellitus（35.9% vs. 18.6%）, fasting time [（16.9±9.5）h vs. （12.2±7.6）h]，incidence of ARDS（74.3% vs. 54.9%） and ARF（43.6% vs. 23.5%），and length of hospital stay [（33.7±19.6）d vs. （21.9±12.9）d]（P<0.05）. In the AAC group，8 patients underwent conservative treatment. 31 patients underwent invasive treatment for severe gallbladder inflammation，among them 20 patients received PTGD and their condition improved. The mortality rates of patients in the AAC group were also higher than that in the non-AAC group （20.5% vs. 8.8%），but there was no statistical significance（P=0.106）. Conclusion    The AAC is one of the common complications in the late courses of SAP. Early diagnosis and individualized treatment are crucial to improve the curative effects. For the patients，the early use of PTGD is a safe and effective treatment method，which is worthy of promotion.

Key words: severe acute pancreatitis, acute acalculous cholecystitis, percutaneous transhepatic gallbladder drainage （PTGD）