超声联合透视引导经皮穿刺引流治疗急性胆囊炎

Percutaneous drainage in the treatment of acute cholecystitis under the guidance of ultrasound combined with fluoroscopy

目的：评估经皮穿刺引流治疗急性胆囊炎患者的安全性及有效性.方法：回顾性分析2009-2013年我院118例有急诊胆囊切除禁忌的急性胆囊炎患者在超声联合透视引导下行胆囊穿刺引流术（Percutaneous transhepatic gallbladder drainage,PTGD）.其中急性结石性胆囊炎患者66例,急性非结石性胆囊炎患者52例,通过对比术前、术后实验室、影像学检查及临床症状的改善评价疗效.结果：118例患者中116例为一次性置管成功,有2例患者为二次置管成功.66例急性结石性胆囊炎患者中,45例炎症痊愈,择期行胆囊切除术,12例不能耐受手术患者无症状长期置管,脱管4例,死亡5例.52例非结石性胆囊炎患者中,44例于引流后3～4周透视下行胆道造影示无梗阻后拔管康复,脱管5例,长期带管2例,死亡1例.结论：超声联合透视引导PTGD治疗急性胆囊炎是一种简单、安全而有效的治疗方法,且非结石性胆囊炎患者采用穿刺引流后的预后效果较结石性胆囊炎患者的预后更为显著.

Objective：To evaluate the safety and efficacy in the treatment of percutaneous gall bladder drainage（PTGD） for acute cholecystitis under the guidance of ultrasound combined with fluoroscopy.Methods：From 2009 through 2013,118 cases of acute cholecystitis who were contraindicated to have cholecystectomy at the time of admission and were treated with PTGD under the guidance of ultrasound combined with X-ray fluoroscopy.Among these patients,66 cases were acute calculous cholecystitis,52 cases had non-calculous cholecystitis.The preoperative and postoperative clinical symptoms,laboratory tests,radiologic examinations were evaluated and compared.Results：The insertion of the disposable drainage catheter was succeeded in 116 cases at the first technical trial and in 2 patients it was succeeded by the second trial.Among the 66 cases of acute calculous cholecystitis cases,45 cases （68.2%） were completely recovered had cholecystectomy thereafter,12 asym tomatic cases（18.18%） who could not tolerate surgery and were given long-term catheterization,drainage catheter detached in 4 cases（6.0%）,5 cases（7.6%） died.While in the 52 cases of non-cauculous cholecystitis,after drainage for 3～4 weeks,cholangiography showed that 44 cases（84.6%） had no obstruction,after extubation were perfectly cured.Catheter detached in 5 cases （9.6%）,2 cases（3.8%） had long-term catheterization,1 case（1.9%） died.Conclusions：PTGD under the guidance of ultrasound and fluoroscopy in the treatment of acute cholecystitis is simple,safe and effective.Prognosis in patients with non-calculous cholecystitis after percutaneous drainage was superior than that in patients with calculous cholecystitis.