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急性胆囊炎

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 9 Apr 2025
最后更新： 03 Nov 2020

小结

定义

病史和体格检查

关键诊断因素

  • 曾发作胆道疼痛
  • 右上腹痛
  • 墨菲征阳性
  • 腹部肿块
完整详情

其他诊断因素

  • 右肩痛
  • 厌食
  • 恶心
  • 发热
  • 呕吐
  • 黄疸
完整详情

危险因素

  • 胆结石
  • 缺乏体力活动
  • 低纤维摄入
  • 严重疾病
  • 外伤
  • 重度烧伤
  • 全胃肠外营养 (TPN)
  • 糖尿病
  • 头孢曲松钠
  • 环孢素
  • 肝动脉栓塞形成
  • 感染
完整详情

诊断性检查

首要检查

  • 全血细胞计数（FBC）
  • C 反应蛋白
  • 肝功能检查 (LFT)
  • 右上腹部超声扫描
完整详情

需考虑的检查

  • 胆道闪烁显像（肝胆亚氨基二乙酸 [HIDA] 扫描）
  • 腹部 CT
  • 腹部 MRI
  • 腹部 X 光
完整详情

治疗流程

急症处理

轻度（I 级）：稳定且无穿孔/坏疽征象

中度（II 级）：稳定，无穿孔/坏疽征象

重度（III 级）：疑似坏疽/穿孔或器官功能障碍

撰稿人

作者

Charles Bellows, MD

Professor of Surgery

University of New Mexico

School of Medicine

Albuquerque

NM

利益声明

CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.

同行评议者

Satyajit Bhattacharya, LVO, MB, MS, MPhil, FRCS

Consultant Surgeon

HPB Surgery Unit

The Royal London Hospital

London

UK

利益声明

SB declares that he has no competing interests.

Stefano Guandalini, MD

Professor of Pediatrics

Chief

Division of Gastroenterology, Hepatology, and Nutrition

University of Chicago Comer Children's Hospital

Chicago

IL

利益声明

SG declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43.全文  摘要

Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54.全文  摘要

Brazzelli M, Cruickshank M, Kilonzo M, et al. Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation. Health Technol Assess. 2014 Aug;18(55):1-101.全文  摘要

Wu XD, Tian X, Liu MM, et al. Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2015 Oct;102(11):1302-13. 摘要

Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16.全文  摘要

Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100.全文  摘要

Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):73-86.全文  摘要

Regimbeau JM, Fuks D, Pautrat K, et al; FRENCH Study Group. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA. 2014 Jul;312(2):145-54.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • 患者教育信息

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