经皮经肝胆囊穿刺引流术后拔管指征的探讨

Study on indications for extubation of percutaneous transhepatic gallbladder drainage

目的 探讨经皮经肝胆囊穿刺引流术（PTGD）术后拔管指征.方法 对2009年1月-2013年12月石河子大学医学院第一附属医院所收治的104例行PTGD的急性胆囊炎患者临床资料进行回顾性研究。结果 全组104例患者均成功置管,腹痛明显缓解时间为0.5～8.0 h,平均（2.3±1.9）h,发热多数可于1d内缓解,置管时间为7～49 d,平均（22.4±10.3）d,其中13例于置管后3～12d意外脱管,5例再次行PTGD,8例给予抗感染、补液等对症治疗,均好转,再置管率为4.8％。78例患者于1～2个月后行腹腔镜胆囊切除术（LC）,手术时间为35 ～ 95 min,平均（52.7±15.0） min,术中转开腹6例（7.7％）,术中出血量30 ～ 150 mL,平均（61.7±31.0） mL。本组无围手术期死亡.结论 行PTGD患者遵循拔管指征准确及时拔管,可有效减少患者带管期间引流管逆行感染、穿刺部位皮肤红肿渗出情况,缩短住院时间,并对后期行LC起到积极影响。

Objective To study the indications for extubation of percutaneous transhepatic gallbladder drainage（PTGD）.Methods Between January 2009 and December 2013,PTGD were performed on 104 patients with acute cholecystitis.The clinical data were analyzed retrospectively.Results PTGD were performed on all 104 patients successfully.In all the patients,after drainage the abdominal pain was relieved within 0.5 to 8 hours and mean time was（2.3 ± 1.9） h.The temperature decreased to normal in 1 days after drainage.The time of drainage was from 7 to 49 days,（22.4 ± 10.3） days on average.Thirteen patients＇tubes were accidentally off during 3 to 12 days,5 patients were performed PTGD again,and 8 patients were given anti-infection,fluid infusion and other symptomatic treatments and all these patients were back to normal in time.Re-intubation rate was 4.8％.In 78 patients laparoscopic cholecystectomy （LC） were performed 1 to 2 months after PTGD.Operation time was between 35 to 95 min and mean time was（52.7 ± 15.0） min.There were 6 patients done open operation and the conservation rate was 7.7％.A mount of blood during LC was 30 to 150 mL,（61.7 ± 31.0） mL on average.No operative deaths occurred during therapeutic session.Conclusions Patients who formed PTGD obey the indications can extubate in time and reduce retrograde infection and skin irritation,also shorten the time during hospital＇s,which will have a positive impact about LC.