目的 探讨急性坏疽性胆囊炎的诊断方法及腹腔镜治疗的效果。方法 收集2017年1月—2019年12月收治的39例坏疽性胆囊炎患者的临床资料,对其诊断方法、手术方式及诊疗结果进行回顾分析。结果 共实施腹腔镜胆囊切除术4 365例,其中确诊为坏疽性胆囊炎患者共39例（0.9%）。39例坏疽性胆囊炎中31例顺利完成腹腔镜胆囊切除术,7例因胆囊三角区暴露不佳而中转行开腹手术,1例高龄患者合并心肺功能障碍直接行开腹胆囊切除术。结论 坏疽性胆囊炎术前诊断困难,B超、上腹部CT等检查均可作为提高术前诊断率的有效方法。腹腔镜可以安全处理大多数坏疽性胆囊炎,对于小部分粘连严重、不能耐受腹腔镜胆囊切除术的患者应及时行开腹手术处理。
Objective To investigate the diagnosis of acute gangrenous cholecystitis and the effect of laparoscopy. Methods The clinical data of 39 cases of gangrenous cholecystitis treated from January 2017 to December 2019 were collected, and their diagnostic methods, surgical methods, and diagnosis and treatment results were analyzed. Results A total of 4365 cases of laparoscopic cholecystectomy （LC） were performed, of which 39 cases were diagnosed with gangrenous cholecystitis, accounting for 0.9% of total LC. Thirty-one of the 39 cases of gangrenous cholecystitis successfully underwent LC, 7 cases were converted to open cholecystectomy （OC） due to obscure anatomy at the triangle of the gallbladder, and 1 elderly patient with cardiopulmonary dysfunction underwent OC. Conclusion The diagnosis of gangrenous cholecystitis is difficult before operation. Ultrasound and upper abdominal CT examinations are effective methods to improve preoperative diagnosis rate. LC can safely treat most gangrenous cholecystitis, and in-time OC is suggested in case of severe adhesions and LC intolerance.
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