Đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị viêm túi mật cấp do sỏi

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Tác giả: Hữu Trí Nguyễn, Minh Tuấn Trương

Ngôn ngữ: Vie

Ký hiệu phân loại: 572 Biochemistry

Thông tin xuất bản: Tạp chí Y Dược học - Trường Đại học Y Dược Huế 2020

Mô tả vật lý: 58-64

Bộ sưu tập: Metadata

ID: 403999

Thêm vào giỏ Liên kết toàn văn

Viêm túi mật cấp do sỏi là bệnh lý tiêu hóa thường gặp. Tuy nhiên điều trị viêm túi mật cấp do sỏi còn nhiều quan điểm khác nhau. Đề tài này được thực hiện với mục tiêu khảo sát đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả sớm điều trị viêm túi mật cấp do sỏi. Đối tượng và phương pháp: Nghiên cứu tiến cứu. Gồm 31 bệnh nhân được chẩn đoán viêm túi mật cấp do sỏi, điều trị tại khoa Ngoại Tiêu hóa Bệnh viện Trường Đại học Y Dược Huế từ tháng 04/2018 đến tháng 04/2019. Bệnh nhân được chẩn đoán viêm túi mật cấp do sỏi theo tiêu chuẩn Tokyo Guidelines 2018. Kết quả: Tuổi trung bình 55,8 ± 19,1 tuổi. Tỷ lệ nữ/nam là 1,8. Bệnh nhân có chỉ số ASA 1 chiếm 38,7%, ASA 2 chiếm 45,2% và ASA 3 chiếm 16,1%. 100% bệnh nhân có đau bụng. Bệnh nhân có sốt chiếm 51,6%, túi mật lớn chiếm 16,1%, nghiệm pháp Murphy (+) chiếm 61,3%. Siêu âm phát hiện sỏi túi mật trên 96,7%. Túi mật thành dày trên siêu âm chiếm 51,6%. 38,7% bệnh nhân có viêm túi mật mức độ nhẹ, 58,1% mức độ trung bình và 3,2% mức độ nặng. 74,2% bệnh nhân được điều trị bằng cắt túi mật nội soi, 25,8% điều trị bảo tồn. Trong nhóm bệnh nhân mổ cắt túi mật nội soi: không có biến chứng lớn trong mổ, không có trường hợp nào chuyển mổ mở cũng như không có tử vong. Ở bệnh nhân điều trị bảo tồn, một trường hợp tử vong do suy đa tạng. Thời gian nằm viện trung bình ở nhóm phẫu thuật là 10,7 ± 3,3 so với 11,3 ± 5,7 ở nhóm điều trị bảo tồn. Mức độ viêm túi mật là yếu tố có mối liên quan đến thời gian nằm viện trung bình., Tóm tắt tiếng anh, Acute calculous cholecystitis is a common digestive disease. However, the treatment of acute calculous cholecystitis has many different perspectives. The aims of this study are to investigate the clinical, laboratory characteristics and to evaluate the early outcomes of acute calculous cholecystitis treatment. Methods: A prospective study consisted of 31 patients, who had undergone treatment for acute calculous cholecystitis at Gastroenterology Department - Hue University of Medicine and Pharmacy Hospital from April 2018 to April 2019. The diagnosis of acute cholecystitis was established according to Tokyo Guidelines 2018. Results: The mean age was 55.8 ± 19.1. Male/female ratio was 1.8. The patients were assigned to ASA 1 (38.7%), ASA 2 (45.2%) and ASA 3 (16.1%). The major symptom was abdominal pain, which was observed in all patients. The proportion of patients with fever was 51.6%, palpable gallbladder (16.1%), positive Murphy's sign (61.3%). Ultrasound findings were: gallstones (96.7%), gallbladder wall thickening (51.6%). According to Tokyo Guidelines 2018, patients were classified into the following 3 grades: mild (38.7%), moderate (58.1%) and severe (3.2%). 74.2% of patients underwent laparoscopic cholecystectomy and 25.8% received conservative treatment. In the surgery group, there were no significant intraoperative complications, conversion to open surgery or mortality. The non-surgery group had one fatal case of multiple organ dysfunction. The mean length of hospital stay of the two groups was 10.7 ± 3.3 and 11.3 ± 5.7 days, respectively. The severity grading of acute cholecystitis was an associated factor with the mean length of hospital stay.

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