術後急性胆嚢炎の重症度と冶療方針に関する臨床的検討 A CLINIRCAL EVALUATION OF THE SEVERITY AND THERAPEUTIC STRATEGIES OF POSTOPERATIVE ACUTE CHOLECYSTITIS

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1980年から1992年までに当科で経験した術後急性胆嚢炎22例を重症例と軽症例に分類し,重症度の差による術後急性胆嚢炎の臨床的特徴について検討した.<br> 術後急性胆嚢炎の重症例は11例認められ,これら重症胆嚢炎症例は原疾患手術後に胆嚢炎以外の重篤な合併症を伴ったものが多く,高齢者に高率に見られた.また原疾患別では消化器癌より心血管疾患に重症胆嚢炎が多かった.重症胆嚢炎11例中死亡例は5例であり,胆嚢摘出術,胆嚢外瘻,保存的治療とも死亡率50%であった.PTGBDは1例のみであったが治癒し,軽症胆嚢炎はほとんど保存的治療で治癒した.重症の術後急性胆嚢炎は原疾患手術後に重篤な合併症を伴ったものや高齢者など抵抗力の弱った状態に多く発症するため,早急に重症度を判定し,重症胆嚢炎にはPTGBDなどのより侵襲の少ない治療法を選択することが重要である.

Twenty-two patients with postoperative acute cholecystitis seen in the department from 1980 to 1992 were divided into two groups by the severity of the condition, namely, mild and severe groups, and compared for the clinical features of the disease.<br> Eleven patients had severe postoperative acute cholecystitis and some of them also had serious complications other than cholecystitis after surgery for the primary disease. This disease was common in the old. Severe cholecystitis was more frequently found in patients with cardiovascular disease as the primary disease than in patients with gastrointestinal carcinoma. Five of the eleven patients with severe cholecystitis died. The mortality was 50% in each patient group undergoing cholecystectomy, cholecystotomy or conservative treatment. Only one patient who underwent PTGBD had a healed lesion. Most patients with mild cholecystitis healed with conservative treatment. It is important to evaluate the severity early on and employ less invasive therapy including PTGBD, because severe postoperative acute cholecystitis often develops in patients with severe other complications after surgery for the primary disease or compromised hosts such as aged people.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(4), 702-707, 1995-04-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008512641
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
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