ĐẶC ĐIỂM LÂM SÀNG VÀ KẾT QUẢ PHẪU THUẬT VIÊM TÚI MẬT CẤP KHÔNG DO SỎI (ACUTE ACALCULOUS CHOLECYSTITIS)

Abstract

Aim of study: 1. Evaluate the clinical and paraclinical feature of acute acalculous cholecystitis (AAC). 2. Surgical result of ACC. - Patient and method: Retrospective study. +Time: 2012-2017. -Result: There were 31 patients, male 14 patients (45,2%), female 17 patients (54,8%), mean age 61,4± 14,3 years (range 46-87). Medical hystory: diabetes mellitus in 6 patients, hypertension in  8 patients, subtotal gastrectomy for gastric cancer in 3; colorectal cancer in 2, intestinal gist in 1. Symptoms: Right upper quadrant abdominal pain  in 31, fever in 11, palpable gallbladder in 11 patients, positive Murphy's sign in 11 patients, rebound tenderness in 9 patients, white blood cell count elevated in all. Abdominal ultrasound revealed thickening of  gallblader wall > 3- 4,5 mm in 20 patients, > 4,5-5 mm in 10,  pericholecystic fluid in 8, peritoneal effusion in 3 patients. CT Scan revealed no stone in gallbladder in 11, thickening gallbladder wall  in 11 with pericholecystic fluid,  peritoneal effusion in 3 patients. Operration performed: Laparoscopic cholecystectomy in 25 patients (3 convertion to laparotomy due to gangrenous cholecystitis and adhesion to common bile duct in 2 and   uncontrollable bleeding in one); laparotomy cholecystectomy in 6 patients, of them 2 performed  partial cholecystctomy and mucous membrance of the remaining gallbladder were scratched  due to gallbladder gangrene  and adhesion to common bile duct. According to the 2018 Tokyo Guidlines: Grade I  acute acalculous cholecystitis in 22 patients, Grade II ACC in 9 patients. There were no death, 1 bile leakage with small volume, 5  surgical site infections. Conclusion: Acute acalculous cholycystitis is characterized by acute inflamation with no calculi. It manifestation of critical systemic disease.  An effective treatment is based on grade of severity. Laparoscopic cholecystectomy is good choice for grade I ACC. In case of  gangrenous cholecystitis, open and  partial cholecystectomy should be done. For patients in critical condition  who cannot tolerate anesthesia and surgery, cholecystostomy by  percutaneous transhepatic gallbladder drainage (PTGD) or  endoscopic transpapilary gallbladder drainage under ERCP  are alternative modality