超声引导下经皮经肝胆囊穿刺治疗化脓性胆囊炎的价值

Valuation of percutaneous transhepatic gallbladder catheterized drainage for acute suppurative cholecystitis under ultrasound guided

目的：探讨在超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎的价值。方法：对30例急性化脓性胆囊炎在超声引导下经皮经肝胆囊穿刺抽脓、甲硝唑反复冲洗，最后注入并保留敏感抗生素，1次／2d，连续1～3次。另对30例经皮经肝胆囊穿刺置管引流（PTGCD）急性化脓性胆囊炎作为对照组（只用甲硝唑冲洗）。结果：两组各30例均穿刺成功。治疗后两组腹痛24h内明显减轻、体温48h内降至正常、血白细胞一周降至正常范围、3～4周B超复查胆囊正常、单纯胆囊壁增厚、胆囊萎缩、胆囊收缩功能正常及并发症的例数分别为：治疗组28，29，30，19，10，1，26，0例；对照组23，22，23，10，18，3，20，8例，其中并发症8例中局部皮肤感染2例，引流管脱落4例，引流管堵塞1例，胆漏1例。两组病程分别为治疗组8．4±2．25d，对照组15．6±5．82d。经统计学处理，除腹痛24h内明显减轻及3～4周B超复查胆囊萎缩两项指标外均有显著性差异。结论：超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎是一种简单、安全、有效的方法。

Objective： To study the valuation of percutaneous transhepatic gallbladder catheterized drainage （PTGCD） with antibiotic for douche and retaining guided by ultrasound for the acute suppurative cholecystitis. Methods： Thirty cases with acute suppurative cholecystitis were treated by percutaneous transhepatic gallbladder catheterized drainage and metronidazole douche and antibiotic retaining. The other 30 cases with the same disease were dealt with only by PTGCD, in which metronidazole was used alone. Results： The both teams were successful in operating, and abdominal pain were improved within 24 hours, the temperature were back to normal within 48 hours, and WBC count back to normal within 1 week. Follow up in 3～4weeks, normal gallbladder, gallbladder by hypertrophy, gallbladder atrophy, normal contraction of gallbladder and complication were respectively 28, 29, 30, 19, 10, 1, 26, 0 in our group, and 23, 22, 23, 10, 18, 3, 20, 8 in control group. And in the8 cases of complication cases, local skin inflammation 2 cases, catheter falling off 4 cases, catheter blocked 1 case, biliary fistula in 1 cases. The day of hospitalization were 8. 4±2.25 days in tour group, and 15.6±8.82 days in control group. Statistically, there was a apparent difference between the two groups. Conclusion： Percutaneous transhepatic galluadder catheterized drainage and antibiotic douche and retaining is an easily operating, safe and effective method for the treatment of acute suppurative cholecystitis .