老年急性结石性胆囊炎伴重要脏器功能障碍患者行序贯微创治疗的疗效

Effect of Sequentially Mini-Invasive Method for Elderly Acute Calculous Cholecystitis Patients Combined with Organ Dysfunction Syndrome

目的探讨序贯微创治疗对伴重要器官功能障碍的老年急性结石性胆囊炎患者的疗效及时机。方法回顾性收集笔者所在医院2012年12月至2013年12月期间笔者所在医院科室收治的67例老年急性结石性胆囊炎且伴重要脏器功能障碍患者的临床资料。67例患者先在B超或CT引导下行经皮经肝胆囊穿刺引流术（PTGBD），同时给予全身抗感染治疗，待全身情况好转后再序贯性择期行腹腔镜胆囊切除术（LC）。结果67例患者均成功完成PTGBD，穿刺成功率为100％；有65例完成PTGBD及其后续检查，与PTGBD前比较，治疗后第1天和第4天患者的腹痛、腹胀、呕吐、白细胞计数、中性粒细胞比值、谷丙转氨酶（GPT）水平、总胆红素（T-bil）水平及c反应蛋白（CRP）水平及体温均明显好转（P〈0．05）。PTGBD后有3例因症状缓解后不考虑手术而拔出引流管，2例中转为开腹小切口胆囊切除术，余60例成功实施了LC。所有患者均于术后2～7d痊愈出院。结论对伴重要器官功能障碍的老年急性结石性胆囊炎患者，序贯微创治疗具有安全、简便、有效、创伤小及患者恢复快的优点。

Objective To explore the curative effect and the appropriate time of sequentially with minimal invasive methods in treatment of elderly acute calculous cholecystitis patients combined with organ dysfunction syndrome （ODS）. Methods Clinical data of 67 elderly acute calculous cholecystitis patients combined with ODS who received treatment in our hospital from December 2010 to December 2013 were collected retrospectively. All of the 67 patients were treated with percutaneous transhepatic gallbladder drainage （PTGBD） under the guidance of B ultrasound or CT at first, as well as systemic anti infective therapy, and then underwent laparoscopic cholecystectomy （LC） sequentially when situation of body got well. Results All of the 67 patients （100%） were treated with PTGBD successfully, but only 65 patients finished the latter related test. For the 65 patients, compared with before PTGBD, the patient＇s pain, abdominal distention, vomiting, leukocyte count, neutrophil ratio, glutamic-pyruvic transaminase, total bilirubin, C-reactive protein, and temperature had gotten obviously better on 1 and 4 d after PTGBD （P〈0.05）. There were 3 patients dropped LC, 2 patients transferred to mini-incision cholecystectomy, and the rest of 60 patients underwent LC successfully. All of the patients recovery and discharged from hospital in 2-7 days after operation. Conclusion Sequentially mini-invasive method is a simple, easy, safe, effective, mini trauma, and quick recovery method for the elderly acute cholecystitis patients combined with the ODS.