[原著］外胆嚢瘻症例の検討 : とくに胆嚢摘出時の胆嚢病変について
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Cholecystostomy is generally considered to be the treatment of choice for acute cholecystitis when the patient's condition is grave or cholecystectomy is technically difficult. Following emergency cholecystostomy, when the patient's condition has improved and acute cholecystitis has subsided, the definitive operation or subsequent cholecystectomy is usually carried out because of the high incidence of recurrent cholelithiasis and acute cholecystitis. The purpose of the present study was to investigate pathology of the gallbladder at the time of subsequent cholecystectomy and thereby to obtain a rationale for subsequent cholecystectomy. Cholecystostomy was performed in twelve patients with acute cholecystitis. Five patients were male and seven, female. The average age was 64.2 years and their ages ranged from 45 to 78 years. Nine patients underwent subsequent cholecystectomy within one month after emergency cholecystostomy, one within two months, one within three months and one within four months. Macroscopically, the resected gallbladders appeared hemorrhagic with the markedly thickened walls. Histologically, the mucosal layer was extensively desquamated. The wall was markedly thickened with connective tissue proliferation and acute inflammatory infiltrates. The Rokitansky-Aschoff sinuses were destroyed and decreased in number. The gallbladders showed acute inflammation with intramural abscesses or histiocytic granulomas in seven patients and acute liberations in five. Periods of the disappearance of the acute inflammatory process of the gallbladder have been reported to range from two weeks to a few months. However, the results of our study suggest that acute cholecystitis does not subside within a few months and may exist for a long time after emergency cholecystostomy despite subsidence of clinical manifestations of acute cholecystitis. These deteriorated gallbladders could cause recurrence of cholelithiasis or acute cholecystitis. So, it is rational that subsequent cholecystectomy should be carried out following emergency cholecystostomy.
- 琉球大学医学部の論文
- 1982-00-00
琉球大学医学部 | 論文
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