急性化脓性胆囊炎患者超声影像学特点及其诊断价值*

doi:10.3969/j.issn.1672-5069.2022.01.029

摘要/Abstract

摘要： 目的总结急性化脓性胆囊炎患者超声影像学检查特点。方法 2019年4月～2021年4月我院诊治的急性单纯性胆囊炎50例和急性化脓性胆囊炎41例,常规进行超声检查,全部患者接受腹腔镜胆囊切除术治疗,术后行组织病理学检查。结果急性化脓性胆囊炎患者超声检查发现胆汁透声差、胆囊肿大、胆囊壁增厚或粗糙和Murphy征阳性率分别为85.4%、92.7%、82.9%和90.2%,均显著高于急性单纯性胆囊炎患者(分别为52.0%、60.0%、62.0%和28.0%,P＜0.05);在41例急性化脓性胆囊炎患者中,经彩色多普勒超声检查,1例(2.4%)被误诊为胆汁淤积,1例(2.4%)被误诊为单纯胆囊结石,3例(7.3%)被误诊为急性单纯性胆囊炎;术前,急性化脓性胆囊炎患者外周血白细胞计数为(15.1±3.5)×10⁹/L,显著高于急性单纯性胆囊炎患者[(9.8±4.9)×10⁹/L,P＜0.05],血清总胆红素水平为(25.3±2.7)μmol/L,显著高于急性单纯性胆囊炎患者[17.1±3.1μmol/L,P＜0.05],血清天冬氨酸氨基转移酶(AST)水平为(97.1±5.6)U/L,显著高于急性单纯性胆囊炎患者[(36.7±4.7)U/L,P＜0.05];术后,血清AST水平为(50.3±4.3)U/L,显著高于急性单纯性胆囊炎患者[(29.8±4.6)U/L,P＜0.05]。结论多普勒超声检查能评价急性化脓性胆囊炎患者的胆囊形态、胆囊壁厚程度、胆汁透声和超声Murphy征,可为诊断急性化脓性胆囊炎提供较为可靠的影像学依据。

关键词: 急性化脓性胆囊炎, 彩色多普勒超声, 胆囊切除术, 诊断

Abstract: Objective The aim of this study was to summarize the ultrasonographic features in patients with acute purulent cholecystitis (APC). Methods 50 patients with simple cholecystitis (SC) and 41 patients with APC were encountered in our hospital between April 2019 and April 2021, and all received sonography, and laparoscopic cholecystectomy. The diagnosis was proven by post-operational histopathological examination. Results The positive rates of poor bile acoustic transmission, gallbladder enlargement, thickened or rough gallbladder wall and positive Murphy sign in patients with APC were 85.4%, 92.7%, 82.9% and 90.2%, all significantly higher than 52.0%, 60.0%, 62.0% and 28.0%, respectively (P＜0.05) in patients with SC; out of 41 patients with APC, the color ultrasonographic examination misdiagnosed as cholestasis in 1 case (2.4%), as simple gallstones in one case(2.4%), and as SC in three cases(7.3%); at presentation, the white blood cell counts in patients with APC was (15.1±3.5)×10⁹/L, significantly higher than [(9.8±4.9)×10⁹/L, P＜0.05], total serum bilirubin level was (25.3±2.7)μmol/L, significantly higher than [17.1±3.1μmol/L, P＜0.05], and serum AST level was (97.1±5.6)U/L, significantly higher than [(36.7±4.7)U/L, P＜0.05] in patients with SC; after surgery, serum AST level was (50.3±4.3)U/L, still significantly higher than [(29.8±4.6)U/L, P＜0.05] in patients with SC. Conclusion Doppler ultrasonography could evaluate gallbladder morphology, gallbladder wall thickness, bile acoustic transmission and Murphy sign in patients with APC, which could provide a reliable imaging feature for the diagnosis of patients with acute purulent cholecystitis.

Key words: Acute purulent cholecystitis, Color Doppler ultrasound, Laparoscopic cholecystectomy, Diagnosis

陈俊光, 邓晓妃, 林树俊, 雷震. 急性化脓性胆囊炎患者超声影像学特点及其诊断价值^*[J]. 实用肝脏病杂志, 2022, 25(1): 116-119.

Chen Junguang, Deng Xiaofei, Lin Shujun, et al. Ultrasonographic features in patients with acute purulent cholecystitis[J]. Journal of Practical Hepatology, 2022, 25(1): 116-119.

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急性化脓性胆囊炎患者超声影像学特点及其诊断价值^*

Ultrasonographic features in patients with acute purulent cholecystitis

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