ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ VIÊM TÚI MẬT CẤP ĐỘ III DO SỎI TÚI MẬT THEO HƯỚNG DẪN TOKYO 2018 TẠI BỆNH VIỆN NHÂN DÂN 115

Abstract

Objectives: Describe the clinical and subclinical characteristics of Grade III acute cholecystitis and assess treatment outcomes, complications and adverse events of Grade III acute cholecystitis according to the Tokyo Guidelines 2018 at People's Hospital 115 from January 2020 to December 2022. Methods: Retrospective, descriptive case series. Results: There were 37 patients meeting the study criteria, with a mean age of 72.15 ± 13.56 years and a male-to-female ratio of 0.85:1. Main clinical symptoms included abdominal pain (100%), fever and anorexia (54.05%), nausea and vomiting (51.35%). Abdominal examination revealed right hypochondrial tenderness (97.3%) and a positive Murphy's sign (89.19%). Ultrasound findings showed gallstones (86.49%), stones ≥1 cm (62.5%), and gallbladder wall thickening ≥1 cm (54.05%). Computed tomography scans indicated gallbladder edema (75.68%), gallbladder necrosis (32.43%), and gallbladder abscess (24.32%). Initial treatment methods were medical therapy with antibiotics (64.86%), laparoscopic cholecystectomy (13.51%), open cholecystectomy (10.81%), and percutaneous cholecystostomy (8.11%). The overall mortality rate was 16.22%, higher in patients with pre-intervention shock (p=0.003). Conclusion: Initial medical treatment with intensive resuscitation focusing on early organ failure control, followed by combining percutaneous cholecystostomy before deciding on cholecystectomy, is an effective and safe method. This approach helps reduce the risk of mortality and postoperative complications.