Clinical Analysis Of 43 Cases Of Acute Acalculous Cholecystitis After Trauma

Objective:To investigate the clinical features of post-traumatic acute acalculous cholecystitis and to evaluate the short-term efficacy of ultrasound-guided gallbladder puncture and surgery.Methods:The clinical data of 43 cases of post-traumatic acute non-calculous cholecystitis in DaLian Medical University teaching hospital(The First Affiliated Hospital of DaLian Medical University,The Second Hospital of DaLian Medical University and The Zhongshan Hospital of DaLian University)for 5 years from October 2013 to October 2018 were retrospectively summarized and analyzed.The incidence of complications(including bile duct injury,biliary fistula,intestinal fistula,peritoneal effusion,incision infection,hemorrhage)and length of hospitalization in 2 weeks were analyzed.Acute post-traumatic non-calculous cholecystitis included criteria:acute non-calculous cholecystitis due to trauma or after surgery;no preoperative imaging and intraoperative calculi.Exclusive criteria:gallbladder and bile duct stones;bile duct injury.All the above-mentioned measurement data are expressed by mean(+standard deviation).Independent sample t test is used to compare the normal distribution of measurement data between groups,and independent sample rank sum test is used to test the non-normal distribution of measurement data.Counting data are described by frequency,and chi-square test is used to compare the normal distribution between groups.All data were processed and analyzed by SPSS20.0,and P value<0.05 showed significant difference.Results:Forty-three cases of post-traumatic acute acalculous cholecystitis in three teaching hospitals of DaLian Medical university were collected,including 20 males and 23 females,aged 54-92 years with an average age of 73.7 years.Trauma can be divided into two categories:trauma and surgical trauma.Of the 20 patients in the operation group,12 underwent open cholecystectomy,6 underwent laparoscopic cholecystectomy,2 underwent cholecystostomy,One patient in the surgical group died of multiple organ failure with a mortality rate of 5%;20 underwent gallbladder puncture and drainage under the guidance of ultrasound in the perforation group,without death;3 underwent conservative treatment,1 succeeded conservatively,and 2 died of septic shock and organ failure,with a mortality rate of 66.7%.The incidence of post-traumatic acute acalculous cholecystitis is special(many basic diseases,such as elderly people with hypertension and diabetes),but it has the characteristics of acute onset,rapid progress,gallbladder gangrene,perforation,inconspicuous symptoms and difficult diagnosis.It needs timely diagnosis and correct treatment.In the diagnosis of this disease,imaging examination(ultrasound,CT,MRI),ultrasound examination is the first choice,CT is an effective supplement to ultrasound.Laparoscopic exploration is both a diagnostic and therapeutic method.In terms of treatment,conservative treatment is easy to lead to death,and conservative treatment is not recommended.Surgical treatment such as cholecystectomy(laparoscopy,laparotomy),cholecystostomy,ultrasound-guided gallbladder puncture and catheter drainage has played a better therapeutic effect.There was no significant difference in preoperative white blood cell count,neutrophil percentage,body temperature,liver biochemistry and pain score between the puncture group and the operation group,P>0.05,with no statistical significance and comparability;white blood cell count,neutrophil percentage,body temperature,pain score decreased faster and hospitalization time was shorter in the puncture group 3 days after operation and 7 days after operation(P<0.05),and complications in the puncture group.Less,short-term effect is better than the operation group.Short-term results This article is more inclined to ultrasound-guided gallbladder puncture catheterization and drainage.Conclusion:1.The incidence of post-traumatic acute acalculous cholecystitis is concealed and easily concealed by the primary disease,which requires great attention.When patients with unexplained abdominal pain after trauma,hepatobiliary ultrasound or abdominal CT should be performed in time to make a definite diagnosis.2.Posttraumatic acute acalculous cholecystitis is characterized by severe inflammation and poor prognosis,which requires timely surgical intervention.3.In the surgical intervention,the short-term effect of ultrasound guided puncture drainage was better than that of the operation group,and the complications were fewer,which laid the foundation for the next step.