Discriminant Analysis And Clinical Application Of Acute Suppurative And Gangrenous Cholecystitis

Objectives To establish a practical, objective and accurate model for pre-operation diagnosis of acute cholecystitis(AC), both quantitative and qualitative analyses were conducted for the clinical data of the AC patients using a retrospective investigation method. On the other hand, AC samples were collected through a prospective investigation way and fitted into the obtained AC model. The predicted value from this model was then compared with the corresponding postoperative pathological diagnosis to verify the model. So that the model can be used to distinguish between acute simple cholecystitis and acute suppurative and gangrenous cholecystitis and also to help clinicians in determining the severity of acute cholecystitis as early as possible and setting out the further treatment to avoid more severe AC by diagnostic errors.Subjects and methods 1. The first strage of our research is establishing the discriminant equation. First, 221 cases that meet the diagnostic criteria for acute cholecystitis(Appendix 1) and also have a definite pathological results after cystic resection were collected from May, 2005 to January, 2014 from department of hepatobiliary surgery, Shenzhen People’s Hospital(2nd Clinical Medical College of Jinan University). Then, the preoperative, intraoperative and postoperative clinical data were studied by means of single factor analysis. Factors that cause acute gangrenous cholecystitis were selected and studied using logistic multiple regression analysis. Finally the corresponding value of these factors was obtained and the discriminant equation for acute gangrenous cholecystitis was established. 2. The second strage of our research is verifying the discriminant equation. The prestoperative clinical data of the AC patients from January, 2014 to February, 2015 in department of hepatobiliary surgery, Shenzhen People’s Hospital(2nd Clinical Medical College of Jinan University) were collected and fitted into the established discriminantequation and the scores were provided. The results were then compared with the intraoperative and postoperative clinical data to verify the discriminant equation. ResultsFrom the first strage research, through factor screening of acute cholecystitis, patient’s age, gender, axillary temperature, obvious abdominal tenderness, history of peritonitis, calculus incarcerated cholecystitis, increased number of days, > 3 days, gallbladder disease, gallbladder wall thickness ≧ edema around 4 mm, gallbladder, white blood cell count, allergic CRP, total bilirubin, triglycerides, and are all closely related to acute suppurative and gangrenous cholecystitis. Then the discriminant equation was established from these data. In the second strage research, preoperative clinical data of the 30 AC patients from January, 2014 to February, 2015 were fitted into the discriminant equation. The coincidence degree between these predicted results and the intraoperative and postoperative clinical data was over 91%. ConclusionsIn present research, preoperative discriminant equation for acute gangrenous cholecystitis suppuration was established through a reasonable analysis and a scientific. This will help clinicians to determine the severity of acute cholecystitis and setting out the further therapeutic plan.