经皮肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性化脓性胆囊炎

Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in the treatment of acute sappurative cholecystitis

目的探讨经皮肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性化脓性胆囊炎的疗效。方法回顾性分析我院及佛山市第一人民医院2009年1月至2012年12月82例急性化脓性胆囊炎先行经皮肝胆囊穿刺引流,1个月后再行腹腔镜胆囊切除术的临床资料。结果 82例患者均成功接受经皮肝胆囊穿刺引流,患者穿刺术后2～4h腹痛明显缓解,术后2至3天体温降至正常。1例术后出现胆道大出血,经急诊肝动脉栓塞止血。全部患者于术后一个月行二期腹腔镜胆囊切除术,其中2例中转开腹(2.4%),术后无胆汁漏及胆管损伤等严重并发症发生。结论急性化脓性胆囊炎经皮肝胆囊穿刺引流可迅速缓解症状,术后1个月再实施腹腔镜胆囊切除术是安全、可行的,中转开腹率低,手术并发症少。

Objective To investigate the effect and potential advantages on percutaneous transhepatic gallbladder drainage （PTGD） combined with laparoscopic cholecystectomy （LC） in the treatment of acute severe cholecyctitis. Methods Retrospective analysis was made on the clinical data of 82 cases of PTGD and two-stage LC for patients with acute severe cholecystitis from Jan 2009 to Sep 2012. Results PTGD was performed successfully for all patients..The symptoms of abdominal pain were relieved 2-4 h after operation,.and the temperature decreased to normal level 48-72 h after operation. . Postoperative massive hemobilia happened in one case and the bleeding stopped by emergently interventional therapy of selective hepatic artery embolization. .And all cases were performed LC 30 days after PTGD,.in which 2 patients were transferred to open cholecystectomy （2.4%）. No patient had severe complication or died after PTGD and LC. Conclusions With the low conversion to open surgery and less complications ,.PTGD combined two-stage LC is simple ,.effective and safe for treatment of acute suppurative cholecystitis.