摘要

CONTEXT:Although few patients with acute abdominal pain will prove to have cholecystitis, ruling in or ruling out acute cholecystitis consumes substantial diagnostic resources.
OBJECTIVE:To determine if aspects of the history and physical examination or basic laboratory testing clearly identify patients who require diagnostic imaging tests to rule in or rule out the diagnosis of acute cholecystitis.
DATA SOURCES:Electronic search of the Science Citation Index, Cochrane Library, and English-language articles from January 1966 through November 2000 indexed in MEDLINE. We also hand-searched Index Medicus for 1950-1965, and scanned references in identified articles and bibliographies of prominent textbooks of physical examination, surgery, and gastroenterology. To identify relevant articles appearing since the comprehensive search, we repeated the MEDLINE search in July 2002.
STUDY SELECTION:Included studies evaluated the role of the history, physical examination, and/or laboratory tests in adults with abdominal pain or suspected acute cholecystitis. Studies had to report data from a control group found not to have acute cholecystitis. Acceptable definitions of cholecystitis included surgery, pathologic examination, hepatic iminodiacetic acid scan or right upper quadrant ultrasound, or clinical course consistent with acute cholecystitis and no evidence for an alternate diagnosis. Studies of acalculous cholecystitis were included. Seventeen of 195 identified studies met the inclusion criteria.
DATA EXTRACTION:Two authors independently abstracted data from the 17 included studies. Disagreements were resolved by discussion and consensus with a third author.
DATA SYNTHESIS:No clinical or laboratory finding had a sufficiently high positive likelihood ratio (LR) or low negative LR to rule in or rule out the diagnosis of acute cholecystitis. Possible exceptions were the Murphy sign (positive LR, 2.8; 95% CI, 0.8-8.6) and right upper quadrant tenderness (negative LR, 0.4; 95% CI, 0.2-1.1), though the 95% CIs for both included 1.0. Available data on diagnostic confirmation rates at laparotomy and test characteristics of relevant radiological investigations suggest that the diagnostic impression of acute cholecystitis has a positive LR of 25 to 30. Unfortunately, the available literature does not identify the specific combinations of clinical and laboratory findings that presumably account for this diagnostic success.
CONCLUSIONS:No single clinical finding or laboratory test carries sufficient weight to establish or exclude cholecystitis without further testing (eg, right upper quadrant ultrasound). Combinations of certain symptoms, signs, and laboratory results likely have more useful LRs, and presumably inform the diagnostic impressions of experienced clinicians. Pending further research characterizing the pretest probabilities associated with different clinical presentations, the evaluation of patients with abdominal pain suggestive of cholecystitis will continue to rely heavily on the clinical gestalt and diagnostic imaging.

译文

背景: 尽管很少有急性腹痛患者会被证明患有胆囊炎,但裁决或排除急性胆囊炎需要大量的诊断资源。
目的: 确定病史和体格检查或基本实验室检查是否清楚地识别需要诊断性影像学检查来诊断或排除急性胆囊炎的患者。
数据来源: 科学引文索引、 Cochrane 图书馆的电子搜索,以及 MEDLINE 索引的 1966年1月至 2000年11月的英文文章。我们还手工搜索了 1950-1965 的医学索引,并扫描了体检、外科和胃肠病学著名教科书中已识别文章和书目中的参考文献。为了识别自综合搜索以来出现的相关文章,我们在 2002年7月重复了 MEDLINE 搜索。
研究选择: 纳入的研究评估了病史、体检和/或实验室检查在患有腹痛或疑似急性胆囊炎的成人中的作用。研究必须报告对照组的数据,发现没有急性胆囊炎。胆囊炎的可接受定义包括手术、病理检查、肝亚氨基二乙酸扫描或右上腹超声,或与急性胆囊炎一致的临床过程,并且没有替代诊断的证据。非结石性胆囊炎的研究包括在内。195 项鉴定的研究中有 17 项符合纳入标准。
数据提取: 两位作者从 17 项纳入的研究中独立提取数据。通过与第三作者的讨论和协商一致解决了分歧。
数据综合: 没有临床或实验室发现有足够高的阳性似然比 (LR) 或低的阴性 LR 来判定或排除急性胆囊炎的诊断。可能的例外是墨菲征 (阳性 LR,2.8; 95% CI,0.8-8.6) 和右上象限压痛 (阴性 LR,0.4; 95% CI,0.2-1.1), 尽管 95% 的 CIs 包括 1.0。关于剖腹手术的诊断确认率和相关放射调查的测试特征的现有数据表明,急性胆囊炎的诊断印象具有 25 到 30 的正 LR。不幸的是,现有的文献没有确定临床和实验室发现的具体组合,这可能是诊断成功的原因。
结论: 没有任何单一的临床发现或实验室测试能够在没有进一步测试 (如右上象限超声) 的情况下产生或排除胆囊炎。某些症状、体征和实验室结果的结合可能具有更有用的 LRs,并可能告知有经验的临床医生的诊断印象。在进一步研究表征不同临床表现相关的预测试概率之前,对提示胆囊炎的腹痛患者的评估将继续严重依赖临床完形和诊断成像。

acute cholecystitis

消化 急性消化道疾病 疾病
概述  :  

急性胆囊炎是一种常见的急性消化道疾病,常由胆囊管梗阻和细菌感染引起,具有起病急,上腹部疼痛,恶心,呕吐等症状,严重时需进行手术,一般预后良好。   急性胆囊炎诊断 MRI/MRCP较超声诊断准确率高,且在鉴别急性胆囊炎病因等方面有着重要的意义;当超声不能明确诊断时,可采用MRI/MRCP等检查。针对坏疽性胆囊炎、气肿性胆囊炎等特殊类型胆囊炎,推荐首选腹部CT、增强CT或MRI等检查。目前的研究结果尚不足以评估彩超和降钙素原在急性胆囊

acute 英 /əˈkjuːt/  美 /əˈkjuːt/

释义   adj. 严重的,[医] 急性的;敏锐的;激烈的;尖声的

例句   The initial, acute phase lasts for about two months after infection.  最初的急性期在感染之后持续约两个月。

 

cholecystitis 英 /,kɒlɪsɪs'taɪtɪs/  美 /,kɑləsɪs'taɪtɪs/

释义   n. [内科] 胆囊炎

例句   Objective: To investigate the causes of cholecystitis after hepatic artery embolization. 目的:探讨肝动脉栓塞后发生胆囊炎的原因。


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