冠心病介入诊疗或搭桥术期间发生急性胆囊炎发作病人的超声引导下经皮胆囊穿刺引流及其临床意义

Ultrasonically Guided Percutaneous Drainage of Gallbladder for Coronary Heart Disease with Acute Cholecystitis during PCI or CABS and Its Clinical Significance

目的探讨超声引导下的胆囊穿刺引流对冠心病介入诊断治疗或搭桥术期间发生急性胆囊炎发作病人治疗价值。方法对7例冠状动脉支架术后病人，3例冠状动脉搭桥术后病人，1例拟行冠状动脉造影病人发生胆囊炎急性发作时实施超声引导下的胆囊穿刺引流，针具为8号PTCD套管针。采用经肝脏胆囊床进入胆囊途径。引流中以超声对胆囊情况进行监测。结果11例患者均一次穿刺成功抽出胆汁，引流出胆汁130-240ml，未发生胆漏和出血等并发症。术后2d病人体温全部恢复正常，复查白细胞总数和中性粒细胞均恢复正常。1周内均拔除了导管，心脏情况恢复顺利。结论超声引导下经皮胆囊穿刺创伤小，能有效缓解和控制胆系感染，对保证冠心病的有创诊断和治疗圆满成功有重要意义。

Objective To assess the therapeutic value of ultrasonically guided percutaneous puncture drainage of gallbladder in the patients with coronary heart disease with outbreak of acute cholecystitis during percutaneous coronary intervention （PCI） or coronary artery bypass surgery （CABS）. Methods Ultrasonically guided percutaneous puncture drainage of gallbladder was performed in seven patients who had undergone PCI, three ones who had undergone CABS and one who was to undergo coronary arteriography in the outbreak of acute cholecystitis, using 8F PTCD canula needle. Percutaneous puncture way （ through liver） into gallbladder was adopted. During draining time, change of gallbladder was monitored. Results In the 11 cases, puncture drainage was successfully performed for the first time. The total volume of bile drained away was 130ml- 240ml. No complication occurred. Two days later, the temperature of the patients became normal, and reexamining leukocytic count and neutrophil leukocytic rate returned to normal. The drainage-tube of all the patients were removed in a week and their heart disease were smoothly recovering. Conclusion Cholecystic inflammation is effectively alleviated and controlled by ultrasonically guided percutaneous drainage of gailbladder, and the treatment and the recovery of the patients with heart disease are ensured.