经皮经肝胆囊穿刺置管引流治疗合并肝硬化的急性胆囊炎

Ultrasound-guided percutaneous transhepatic gall bladder drainage for acute cholecystitis in patients with liver cirrhosis

目的探讨经皮经肝胆囊穿刺置管引流治疗对合并肝硬化门静脉高压症的急性胆囊炎患者的安全性及疗效。方法回顾性分析于2013年9月到2014年12月进行经皮经肝胆囊穿刺置管引流术治疗的合并肝硬化高压症急性胆囊炎患者12例。其中,肝功能Child-pugh A级7例,Child-pugh B级5例,分析12例患者经皮经肝穿刺胆囊置管引流术后并发症发生情况、术后炎症消退情况、术前后肝功能变化情况。结果 12例患者均通过皮经肝胆囊穿刺置管引流术治疗后胆囊炎症消退,并择期成功行腹腔镜下胆囊切除术。其中,有2例患者因穿刺出现腹腔内出血,后经保守治疗后出血停止。无胆瘘发生。术后部分患者肝功能有所改善。结论经皮经肝穿刺胆囊置管引流治疗对合并肝硬化的急性胆囊炎是一种安全的治疗方法 ,可作为后续安全地施行腹腔镜下胆囊切除术的过渡。

Objective To investigate the effectiveness and safety of ultrasound-guided percutaneous transhepatic gallbladder drainage for acute cholecystitis in patients with liver cirrhosis. Methods There were 12 cases included in the retrospective study..All patients with liver cirrhosis and portal hypertension suffered from acute cholecystitis and received ultrasound-guided percutaneous transhepatic gall bladder drainage during December 2013 to December 2014. There were 7 cases with liver function of Child-pugh A, and 5 cases with Child-pugh B. Postoperative complications, inflammation resolution and improvement of liver fuction of the 12 cases were analyzed. Results All 12 cases achieved inflammation resolution of the gall bladder after ultrasound-guided percutaneous transhepatic gallbladder drainage,.and received laparoscopic cholecystectomy..Two cases presented with intraperitoneal hemorrhage, and cured with conservative treatment. All 12 cases presented with no other complication,and some cases presented with improvement of liver function. Conclusion Ultrasound-guided percutaneous transhepatic gallbladder drainage was safe and effective for acute cholecystitis in patients with liver cirrhosis, who can subsequently receive laparoscopic cholecystectomy safely.