经皮经肝胆囊穿刺治疗老年急性非结石性胆囊炎疗效分析

Effects analysis on percutaneous transhepatic gallbladder drainage in treatment of acute acalculous cholecystitis in elderly patients

目的探讨超声引导下经皮经肝胆囊穿刺治疗老年人急性非结石性胆囊炎（acute acalculous cholecystitis,AAC）的临床疗效。方法回顾性分析2010年3月～2014年8月我院对38例老年急性非结石性胆囊炎患者行超声引导下经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage,PTGBD）的效果,观察术后疗效。结果38例患者顺利置入引流管,获得有效胆汁引流,成功率100%,1例合并冠心病患者死于急性心肌梗死,37例患者经有效的减压引流后术后24～48 h后腹痛减轻,48～72 h平均体温逐渐由术前38.4℃降至术后36.9℃,白细胞数由术前15.4×10^9/L降至7.1×10^9/L,谷丙转氨酶由术前126.8 U/L降至术后28.3 U/L、总胆红素指标由术前50.4μmol/L降至术后22.8μmol/L,差异均有统计学意义（P〈0.05）,术后3 d逐渐恢复饮食,34例患者胆汁培养主要包括大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯杆菌、厌氧菌,4例患者胆汁培养无细菌。术后2^3周拔除引流管,无出血、胆瘘、结肠损伤等并发症。结论对于难以耐受手术的老年急性非结石性胆囊炎患者,PTGBD操作简单、安全有效、符合损伤控制外科原则,值得推广。

Objective To discuss the effects of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD）in treatment of acute acalculous cholecystitis（AAC） in elderly patients. Methods 38 elderly patients with AAC and receiving PTGBD from March 2010 to August 2014 were reviewed and the effects after operation were observed. Results Drainage tube placement and biliary drainage were successfully conduced in all the 38 patients（100%）. One patient combined with coronary heart disease died of acute myocardial infarction. The other 37 patients reported relief of abdominal pain after 24-48 hours of drainage. At 48-72 h after operation, the average body temperature of patients was lowered from 38.4℃ before operation to 36.9℃, the white blood cell count was reduced from 15.4×10^9/L to 7.1×10^9/L,glutamic-pyruvic transaminase was reduced from 126.8 U/L to 28.3 U/L, and the total bilirubin was reduced from50.4 μmol/L to 22.8 μmol/L, all these differences were significant（P〈0.05）. Food and drink intake was gradually regained after 3 days postoperation. The bile bacteria culture showed that in 34 patients, the bacteria were mainly escherichia coli, staphylococcus aureus, klebsiella pneumonia, and anaerobic bacteria, and the other 4 patients showed no bacteria.The drainage tube was removed at 2-3 weeks after operation, no complications such as hemorrhage, biliary fistula, or colon injury was observed. Conclusion For elderly patients with AAC and cannot tolerate surgeries, PTGBD is a simple operation with high safety and effectiveness, which conforms to the damage control surgery principle and is worthy to be promoted.