重症胆道感染中经皮经肝胆囊引流的临床应用价值

The practical value of ultrasound-guided percutaneous transhepatic gallblader draining in the treatment of acute severe infection of biliary tract

目的探讨重症胆道感染经皮经肝胆囊引流（percutaneous transhepatic gallblader draining，PTGD）的临床应用价值。方法选择我院2003年3月至2008年5月收治的35例因胆石症、胆道肿瘤所致重症胆道感染伴阻塞陛黄疸，在超声引导下行PTGD。结果全组PTGD均获成功，12-48h内病人发热、腹痛症状迅速缓解，黄疸减退，很陕脱离危险。1～5d后复查B型超声，胆囊水肿、胆囊周围渗出消失，肿大的胆囊迅速恢复正常，未发生胆漏、出血、气胸等并发症。结论应用PTGD行胆道引流治疗急性重症胆道感染创伤小、安全、有效、易行，能迅速改善病人症状，并发症少，具有很高的临床实用价值。

Objective To investigate the practical value of ultrasound-guided percutaneous transhepatic gallblader draining（ PTGD） in the treatment of acute severe infection of biliary tract. Methods Ultrasound-guided PTGD was performed on 35 patients with acute pyogenic cholecystitis, acute severe cholangitis or malignant obstructive jaundice from March 2003 to May 2008. Results PTGD was performed successfully on 35 cases. In all of the patients, symptoms of pyrogenic and abdominal pain were rapidly relieved in 12-24h. The complication of jaundice gradually disappeared after the treatment. The patients were out of danger rapidly. The pericholecystitis disappeared after 1-5 days on the ultrasound. There were no bleeding, biliary fistula and biliary peritonitis. Conclusion Ultrasoundguided PTGD is an effective alternative for bile duct drainage, with the advantages of minimal invasion, simplicity and accurateness of performance, safety and fewer complications. It presents much clinical value for acute severe infection of biliary tract.