非結石性 膽囊炎에 關한 臨床的 硏究 = A Clinical Study on the Acalculous Cholecystitis

다국어 초록 (Multilingual Abstract)

A clinical study was undertaken on the 35 cases of acalculous cholecystitis among 392 cases operated for the biliary disease during the period from. January 1980 through June 1987 admitted in the department of surgery Chungnam National University Hospital.
The results obtained were as followings;
1. The incidence of acalculous cholecystitis was 8.9% and extragallbladder biliary stone 3.1% among all cholecystitis.
2. The incidence of acalculous cholecystitis was slight more prevalent in female in contrast to many reports, i. e. the ratio of male to female was 1 : 1.2.
3. In regard of the age distribution, 5th decade was most prevalent, followed by 7th, 4th, & 6th decade in order of frequency; 91.4% of all patients were older than 30 years.
4. Right upper quadrant pain (74%) was most frequent clinical symptom, followed by nausea and vomiting (57%), fever & chillness (54%), & epigastric pain (37%) in order of frequency.
5. 37% of patiients was within one week of duration of symptoms, 14% between 1∼2 weeks, & 63% of patients within 4 weeks,
6. Right upper quadrant tenderness (77%) was most frequent positive physical finding,
followed by jaundice (26%), & right upper quadrant mass (20%).
7. The elevated SGPT(74%) was most frequent positive laboratory finding, followed by elevated SGOT (69%), elevated serum bilirubin above 1. 5mg% (66%), above 3.0mg% (40%), leukocytosis (37%) & elevated alkaline phosphatase (37%).
8. Ileus on simple abdomen (60%) was most frequent finding as diagnostic measures, nonvisualisation of gallbladder in oral cholecystography or cholescintigraphy (17%) ; in most cases, the findings were nonspecific, therefore it can be said that clinical findings were most important in the diagnosis of acalculous cholecystitis.
9. Preoperatively, it was diagnosed as chronic cholecystitis (37%), empyema gallbladder (11%), gallbladder stone (11%), choledocholithiasis (9%), & acalculous cholecystitis (6%). i. e. the preoperative diagnostic accuracy was very low.
10. The most frequent operation underwent was cholecystectomy with or without T-tube drainage (86%), followed by cholecytostomy (9%), & choledochojejunostomy (5. 7%).
11. Bile culture was performed in 14 cases, 79% being positive, among them E. coli was most frequent (29%), followed by Klebsiella (21%), Proteus mirabilis, Streptococcus intermidius, & Streptococcus epidermidis.
12. Regarding etiologic and predisposing factors, ascaris was found in 14% of cases, Clonorchis sinensis (9%), & common bile duct cancer (9%), gallblader cancer (9%), pancreas head cancer (6%), & unclear(37%).
13. Postoperative complications were developed in 8 cases (23%), among them wound infections were most frequent (4 cases), followed by wound dehiscence (1 case), intraabdominal abscess (1 ,case), biliary fistula (1 case), & cholangitis (1 case).