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1、1Acute cholecystitis timing of surgery and surgical methods of discussion papersPaper Network: acute cholecystitis on the best timing of surgery has been controversial, is generally believed that within 72 hours of the onset of surgery is appropriate. This paper analyzes 216 cases of acute exacerbat
2、ion of gallbladder surgery cases, including 75 cases of onset more than 72 hours, depending on the circumstances the implementation of different surgical: cholecystectomy, gallbladder mucosal excision, cholecystostomy, have achieved satisfactory results, are as follows. Clinical data 1.1 General inf
3、ormation on emergency gallbladder surgery, 216 cases, 37 males, female 179 cases. The oldest 80 years old, minimum 19 years, mean 53 years of age. 60 98 (45%) incidence of the shortest 23 hours, up to 8 days , an average of 64 hours associated with cardiovascular disease or diabetes, 35 patients (16
4、%), accompanied by jaundice in 18 cases (8.3%) confirmed by surgery gallbladder pathology: 2edema 136 cases (63%), type 49 cases of purulent (23%), gangrene type in 31 cases (14%). gallbladder pathology and age of onset, time of onset in Table 1. Table 1 gallbladder pathology and the relationship be
5、tween age of onset and time 1.2 Methods and results of surgical procedures: cholecystectomy in 159 cases (73.6%), gallbladder mucosal excision in 53 cases (24.5%), cholecystostomy in 4 cases (1.9%), common bile duct exploration in 18 cases (8.3%). days of hospitalization up to 64 days, the shortest
6、9 days, an average of 12.7 days of surgical complications: biliary fistula in 3 cases, common bile duct injury in 2 cases, wound infection in 6 cases no operative deaths in this group. relationship between surgical and surgical complications in Table 2. Table 2 surgical and surgical complications re
7、lationship (cases) 2 Discussion 2.1 duration of acute cholecystitis with the relationship between timing of surgery for acute cholecystitis with perforation, bile peritonitis, abscess 3around the gallbladder, biliary obstruction, acute pancreatitis, liver abscess and other patients need emergency su
8、rgery has reached a consensus for uncomplicated patients with acute cholecystitis is still controversial when surgery is appropriate is generally believed that, such as acute onset has been more than 72 hours, due to severe local tissue edema, gallbladder triangle unclear anatomy, surgical difficult
9、y, postoperative complications, it is due may be treated conservatively, for the inflammation subsided after 6-12 weeks before elective surgery, but because of individual differences in the ever-changing, and hospital conditions, physician experience, patients economic conditions vary, it is difficu
10、lt for the general principle to determine all patients the timing of surgery Some patients with recurrent in the short term, but some patients because of economic or other urgent reasons for an early surgery, even in patients with acute exacerbation of these more than 72 hours, according to current
11、medical standards, in some cases can be considered emergency surgery duration of disease pathological changes are not necessarily proportional to 32 patients in this group the 4incidence of more than 72 hours, but the pathological changes of the gallbladder shows a simple type, surgical difficulty i
12、s not high. general acute abdominal pain, times of counting time, some patients with impacted stones not serious, abdominal pain when light weight, slow progression, fever and peritoneal irritation appeared later, signs of mild, but some cases, especially in elderly or patients with atherosclerosis,
13、 rapid onset, earlier onset of chills, fever and significant peritoneal irritation, the course is not long, but the local pathological changes in severe gallbladder. Also some cases in which the early onset of a positive but not very effective conservative treatment, resulting in a longer duration i
14、s difficult to determine the local pathological changes in this group, 37 patients with onset 72 hours, but the pathological changes of suppuration or gangrene type . shows that the incidence of time as one of the factors that determine the timing of surgery, not mechanical, in isolation, not simply
15、 to determine the onset time to the extent of gallbladder disease, but with signs of change, the past treatment of the situation and the patients age, concomitant diseases considering the comprehensive 5analysis of the situation in this group the incidence of more than 72 hours before surgery, 75 ca
16、ses, accounting for 34.7%, postoperative complication rate of 5%, while acute surgical cases less than 72 hours the number of 141 cases, accounting for 65.3%, surgical complication rate was 4.9%, no significant difference in the two groups, indicating the onset timing of surgery is not an absolute indicator. In short, for a specific patient, there should be a specific treatment plan. Links to free download http:/ 2.2 choice of surgical approach for ac
