Zusammenfassung
Die akute Galle wird seit über 50 Jahren in zunehmender Häufigkeit beobachtet, eine Besonderheit stellt sie als Komplikation schwerer Erkrankungen nach großen Operationen oder Traumen dar. Das Krankheitsgeschehen ist multifaktoriell und die Symptome sind häufig infolge einer Analgetika- und Beatmungstherapie überdeckt. Patienten und Methoden: prospektiv wurden auf der Chirurgischen Intensivstation Patienten im postoperativen und posttraumatischen Verlauf mit dem Krankheitsbild der akuten Galle erfasst. Die klinischen Ergebnisse, Laboranalysen und angewendete Diagnostika wurden ausgewertet. Ergebnisse: Trotz der Fortentwicklung der Intensivmedizin einer ausgeweitetenen Diagnostik, eine schonender Anästhesieverfahren und Operationstechniken war die Gesamtletalität der Schwerkranken mit 30% hoch, die Komplikation „akute Galle” aber mit 4/47 (8,5%) sehr niedrig. Entscheidend für die Prognose sind eine frühzeitige Diagnose und die Sofortoperation, dass heißt die Operation innerhalb von 6 Stunden nach Diagnosestellung. Ziel ist die ein-, gelegentlich eine zweizeitige Cholezystektomie nach ultraschallgesteuerter Cholezystostomie.
Abstract
Acute acalculous cholecystitis can be a complication of severe illness in patients who have undergone major surgery or have had extensive trauma. The incidence appears to have increased over the past 50 years. The aetiology is multi-factorial while the symptoms and signs, as seen in an Intensive Care Unit, are often less obvious and non-specific due to the use of analgesia and assisted ventilation. Patients and methods: This was a prospective study in patients who were admitted to a surgical Intensive Care Unit post-operatively or following major trauma who developed cholecystitis. The clinical results, laboratory analyses and diagnostic procedures were analysed and evaluated. Results: Even though there have been significant improvements in surgery, anaesthetics and Intensive Care Medicine the mortality of severly ill patients remains about 30%. The mortality of patients with cholecystitis is 8.5%. Prompt surgery with cholecystectomy within 6 hours of diagnosis is crucial but in selected cases ultrasound guided cholecystostomy is necessary prior to cholecystectomy.
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1 Beide Autoren haben zu gleichen Teilen an der Arbeit mitgewirkt
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