Risk Factors Of Acute Cholecystitis Complicated With Gallbladder Perforation

Objectives:Gallbladder perforation(GBP)is a rare but serious complication of acute cholecystitis(AC).The clinical manifestations of some patients with GBP are similar to those of AC.delayed diagnosis and surgical intervention lead to higher mortality.This study analyzed the related factors of AC complicated with GBP,and sought the independent risk factors of AC complicated with GBP.Further,we explored the risk factors,and provided theoretical basis for early diagnosis and detection of high-risk patients,so as to reduce the incidence rate and mortality of GBP.Methods:the clinical data of 128 patients with AC who met the screening criteria from January 2018 to October 2020 in Department of hepatobiliary and pancreatic surgery,Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed.According to whether there was perforation in the gallbladder,they were divided into non perforation group(n=98)and perforation group(n=30).general clinical data of the two groups(sex,age,history of gallstone,history of diabetes,history of cardiovascular disease(including hypertension,coronary disease,arrhythmia),BMI,temperature of admission,whether to chill or not),systemic infection index(PCT,hsCRP,WBC),liver function index(ALB,ALT,AST,ALP,TBIL),imaging data(gallstone in neck of gallbladder,thickness of gallbladder wall,gallbladder volume,fatty liver,liver cirrhosis,perigallbladder effusion)were statistically analyzed to explore the correlation between them and GBP,and finally the independent risk factors of AC complicated with GBP were obtained.Results:The clinical data of 128 patients with AC were collected,including 98 cases(76.6%)in non perforation group and 30 cases(23.4%)in perforation group.Univariate analysis showed that there were significant differences between the two groups in general clinical data(gender,age,history of diabetes,history of cardiovascular disease,T≥38.5℃);infection related indicators and liver function indicators(WBC≥15×109,ALB);imaging data(gallbladder neck stones,peri gallbladder effusion)(P<0.05)Therefore,it is a risk factor for AC complicated with GBP.Multivariate logistic regression analysis showed that age,cardiovascular disease,T≥38.5℃,gallstone in neck of gallbladder and hydrops around gallbladder were independent risk factors of AC complicated with GBP,while elevated ALB was protective factor of AC complicated with GBP.Conclusions:1.The results of this study show that the risk factors of GBP in AC patients include:male,age,diabetes mellitus,cardiovascular disease,T≥38.5℃,WBC≥15.0×109,level of ALB,gallstone in neck of gallbladder,and fluid around gallbladder;among age,cardiovascular disease,T≥38.5℃,gallstone in neck of gallbladder and hydrops around gallbladder were independent risk factors,and elevated ALB level was protective factor of GBP.2.AC patients with GBP are more risk factors.We should fully understand their risk factors and protective factors,and make early diagnosis and take effective intervention measures to reduce the incidence rate and mortality of GBP patients with high risk of GBP.