胆囊穿刺置管引流对肠瘘合并胆汁淤积病人感染及营养状况的影响

Impact of percutaneous transhepatic gallbladder puncture drainage on the infection and nutritional status of intestinal fistula patients with cholestasis

目的：探讨超声引导下经皮经肝胆囊穿刺引流术治疗肠瘘合并胆汁淤积的疗效。方法：总结分析18例行超声引导下经皮经肝胆囊穿刺引流术治疗肠瘘合并胆汁淤积病人的临床资料。结果：穿刺置管均一次成功，无严重并发症发生，13例病人穿刺前有发热，穿刺后24h体温均有所下降。13例白细胞（WBC）高于正常值，穿刺后24h白细胞下降，且有统计学差异（P〈0．05），穿刺后1周呈逐渐下降趋势。18例病人谷酰转肽酶（GGT）均升高，穿刺后3d显著下降（P〈0．05）；所有病人营养状况均有所改善，清蛋白、前清蛋白逐渐上升（P〈0．05）。18例病人中3例因多器官功能障碍于穿刺后7～20d死亡，其余均在穿刺后3～4周夹闭导管无异常后将其拔除。结论：超声引导下胆囊穿刺引流术作为一种微创治疗手段，可有效地解除胆囊腔内压力，降低感染的发生率，改善肠瘘病人的营养状态。

Objective ： To observe the efficacy of percutaneous transhepatic gallbladder catheteri- zing drainage （PTGCD） on the treatment of intestinal fistula with cholestasis. Methods： The clinical data of 18 intestinal fistula patients with cholestasis receiving PTGCD were analyzed retrospectively. Results： This operation was performed successfully in all patients in one time, and there were no bleed- ing, biliary fistula and other complications. The body temperature decreased in 24 hours after the punc- ture. The number of white blood cells was significantly decreased in 24 hours after PTGCD （ P 〈 0.05 ）. The level of GGT decreased significantly after 3 days （ P 〈 0.05 ）. The nutritional status had improved. Conclusion： PTGCD as a minimally invasive treatment can effectively release the pressure of the gallbladder, reduce the incidence of infection, and improve the nutritional status of patients.