经皮经肝胆囊穿刺引流术在高龄高危急性胆囊颈部结石嵌顿中的急诊应用

Percutaneous transhepatic gallbladder drainage for acute cholecystitis in the elderly and high riskpatients

目的总结超声引导下经皮、经肝胆囊穿刺引流（PTGD）对高龄、高危急性胆囊颈部结石嵌顿患者的治疗经验。方法回顾性分析2001-01-2008-12期间接受PTGD治疗的56例高龄、高危急性胆囊颈部结石嵌顿患者的临床资料。结果56例均穿刺置管成功，其中6例因引流管脱落或堵塞而再次行PTGD。54例（（96．43％）获得有效的胆囊引流，52例（92．85％）治愈。40例于急性胆囊颈部结石嵌顿治愈后2周至3个月行择期胆囊切除术。1例发生胆囊出血，2例出现胆汁腹腔漏。全组无一例因急性胆囊颈部结石嵌顿及相关的治疗而死亡。结论PTGD是治疗高龄、高危急性胆囊颈部结石嵌顿患者的一项安全、简便、有效的方法。

Objective To sum up the experience of the treatment of elderly and high risk patients with acute cholecystitis by ultrasound - guided percutaneous transhepatic gallbladder drainage （ PTGD ）. Methods The clinical data of 56 patients who underwent PTGD between January 2001 and December 2008 were analyzed retrospectively. Results PTGD was successfully performed in all the patients. This procedure was repeated in 6 cases because of downfall or block of drainage catheter. Gallbladder drainage was effective in 54 patients { 96.43% ） , 52 patients （ 92.85% ） were cured. Selective cholecystectomy was performed in 40 cases from 2 weeks to 3 months after PTGD. Three patients underwent chemical resection. Gallbladder hemorrhage occurred in 1 case, and bile leakage occurred in 2 patients. No patient died of acute cholecystitis. Conclusion PTGD is a safe, simple and effective methods for the treatment of elderly and high risk patients with acute cholecystitis.