B超引导下经皮经肝胆囊穿刺造瘘术在老年急性胆囊炎中的应用(附32例报告)

The effect of B-scan ultrasonography assisted PTGCD in treating acute cholecystitis in elderly patients: an analysis of 32 cases

目的观察B超引导下经皮经肝胆囊穿刺造瘘术(percutaneous transhepatic gallbladder catheterizing drainage,PTGCD)治疗老年急性胆囊炎的临床疗效。方法对32例有胆囊切除禁忌的老年急性胆囊炎患者,在超声引导下行PTGCD,并对其临床资料进行分析总结。结果 32例中,一次性置管成功率100%(32/32)。术后1～3天临床症状缓解率96.9%(31/32),无严重的穿刺并发症发生。3例非结石性胆囊炎患者于引流后3～4周造影示无胆囊管梗阻后拔管。29例结石性胆囊炎患者,1例置管后症状继续加重,术后第5天因呼吸衰竭死亡;5例不能手术而长期置管的患者中有3例死于肿瘤等其它疾病,2例在随访期6～14个月无任何临床症状;23例于术后3个月择期行胆囊切除术,术后恢复顺利。结论 PTGCD对有胆囊切除术禁忌的老年急性胆囊炎患者是一种简单、安全、有效的急诊处理方法。

Objective To examine the effect of B-scan ultrasonography assisted percutaneous transhepatic galll,ladder catheterizing drainage （PTGCD） in treating acute cholecystitis in elderly patients. Method The data obtained from 32 cases in which the patients did not favour the removal of gallbladder were analyzed. Result Among the 32 cases, the one-time intubation success rate was 100%. 1 to 3 days after treatment, clinical symptom relief rate was 96.9%. No serious complications were observed. 3 patients with non-acalculous eholecystitis received extubation 3 or 4 weeks after treatment as angiography showed no cystic duct obstruction occured. Among the rest 29 patients with calculous cholecystitis, one bore the symptom that the disease exacerbated and eventually died of respiratory failure five days after treatment; Five patients were diagnosed as not suitable for surgery and in need of long-term catheterization, where three died of tumor and other diseases and two patients did not appear to bear any clinical symptoms during the follow-up visits six to fourteen weeks after treatment; 23 patients received surgery of gallbladder removal within 3 months after treatment and experienced successful postoperative recovery. Conclusion B-scan ultrasonography assisted PTGCD as a technology for treating acute cholecystitis in elderly patients who do not favour gallbladder removal can be a simple, safe, and effective method.