PTGBD在老年急性梗阻性胆囊炎治疗中的应用

Clinical Efficacy of Percutaneous Transhepatic Gallbladder Gallbladder Drainage in Treatment of Cholecystitis in Elderly Patients with Acute Obstructive Cholecystitis

目的探讨在CT定位下行经皮经肝胆囊穿刺引流术（percutaneous transhepafic gallbladder drainage,PTGBD）治疗老年急性梗阻性胆囊炎的临床效果。方法对我院2011年1月—2014年6月接受PTGBD治疗的老年急性胆囊炎15例的临床资料进行回顾性分析。结果本组穿刺成功率100%,均成功置入引流管,术后保持引流通畅,引流胆汁从浑浊开始逐渐清亮,引流效果满意,引流量200-500 ml/d。所有患者在穿刺后48-72 h体温逐渐恢复,腹痛缓解,腹部体征减轻,复查血白细胞均恢复正常。术后3~4周拔除引流管。PTGBD治疗后4周,5例合并胆总管结石者2例返院行胆囊切除＋胆总管切开探查取石＋T管引流术,3例行逆行胰胆管造影＋十二指肠乳头括约肌切开术;3例单纯胆囊结石行腹腔镜胆囊切除术。术后出现并发症5例,其中2例堵管,2例导管脱落,1例出血,予对症处理后缓解。结论对于老年急性梗阻性胆囊炎暂不具备手术条件的患者,行PTGBD操作简单,临床效果确切,是一种较好的治疗方案。

Objective To investigate and analyze the clinical efficacy of percutaneous transhepatic gallbladder drain-age （PTGBD）guided by CT in acute obstructive cholecystitis in elderly patients. Methods Retrospective analysis of clinical data and therapeutic effect of 15 patients with acute cholecystitis who received PTGBD in our hospital during January 2011 and June 2014 was made. Results The 15 patients were successfully placed with drainage and the bile began to clear from turbid after drainage of 200-500 ml bile every day and the success rate were 100% in the group. Within 48 to 72 hours after punc-ture, the temperature gradually returned to normal, abdominal pain was relieved, abdominal signs disappeared in all the 15 patients, and the review of blood leukocytes were normal. The drainage tube was removed in 3 or 4 weeks after PTGBD. Two of the five patients complicated with common biliary stones underwent cholecystectomy and T tube drainage after PTGBD in 4 weeks and 3 patients underwent ERCP/ EST. 3 patients of simple gallbladder stones underwent laparoscopic cholecystectomy. Five patients in the group had complications after the operation, including two cases of blocked tubes, 2 cases of catheter loss, one case of bleeding, but all were relieved after symptomatic treatment. Conclusion For elderly patients with acute obstruc-tive cholecystitis who are not suitable for surgical procedures, the therapy of PTGBD is preferred as a treatment program.