彩色多普勒超声引导下经皮经肝胆囊穿刺置管引流术在危重患者中的应用

Percutaneous transhepatic gallbladder drainage under color Doppler ultrasound in critically ill patients

目的：探讨彩色多普勒超声引导下经皮经肝胆囊穿刺置管引流术（PTGD）在病情危重合并急性胆囊炎患者中的应用。方法：53例危重患者，男33例，女20例，年龄为13～84岁，平均（57±5）岁。在彩色多普勒超声引导下，穿刺针经1．5—2．5cm的肝组织后穿过胆囊床进入胆囊腔内，退出针芯，放人导丝，拔出穿刺针，沿导丝送入单腔中心静脉导管，抽出导丝，抽尽胆汁，用甲硝唑液冲洗胆囊至抽出液变清。结果：53例患者均一次穿刺成功，手术后右上腹疼痛症状立即缓解。手术后24h体温及白细胞明显下降，5d后恢复至正常水平。7例胰头癌或胆管癌患者术后3d，巩膜及皮肤黄染基本消退，谷丙转氨酶及谷草转氨酶恢复正常水平。结论：彩色多普勒超声引导下的PTGD，对于危重不能耐受手术或难以施行手术的患者，是一项安全、经济、易于操作、并发症少、成功率高的治疗手段。

Objective：To study percutaneous transhepatic gallbladder drainage （PTGD） under color Doppler ultrasound in critically ill patients with acute calculus cholecystitis. Methods ： A paracentetic needl was stuck into the cholecyst after going straight through 1.5 - 2.5 cm hepar under color Doppler ultrasound. The operator took out the bullet core, put in a guide wire, extracted the needl, inserted a central venous catheter along the guide wire, and then drew out the bile and clusised the cholecyst with metronidazole until the extracted fluid was clear and bright, Results：PTGD immediately relieved the pain in the of upper right quadrant in all the patients. Body temperature and WBC descended obviously 24 hours and returned to normal 5 days after the operation. Conclusion：Color Doppler ultrasound guidedPTGD, easy to perform and with few complications and high suness rate, is an returned effective and reliable procedure for critically ill patients who are intolerant of cholecystectomy or for whom the operation is difficult to perform.