经皮经肝V段胆囊穿刺外引流在特殊人群急性胆囊炎中的应用

The application of PTGBD by liver V section in special groups of acute cholecystitis

目的探讨超声引导下选择经皮、经肝V段胆囊穿刺外引流的可行性及有效性。方法回顾性分析我院2008年1月~2013年12月53例特殊人群急性胆囊炎的治疗,其中应用经皮、经肝V段胆囊穿刺外引流治疗后择期手术22例;未经穿刺引流急诊手术的31例,比较2组采取不同治疗方案病人术前临床资料及手术时间、出血量、平均住院日、并发症情况。结果经皮、经肝V段胆囊穿刺外引流治疗组所有患者均顺利成功置管,患者的腹痛、寒战发热等症状迅速缓解,术后1~3天白细胞均恢复正常。全组未出现明显并发症(出血、胆漏、引流管滑脱等),均择期于1至3月内行胆囊切除术而治愈,无死亡病例。急诊手术治疗组术中出血量50 ml^600 ml,术中行胆囊大部分切除2例。术后1例并发感染性休克、呼吸功能衰竭转ICU后治愈;胆瘘2例,其中1例经引流后自愈,1例再次手术后治愈(术中证实为右肝管损伤);术后并发切口感染4例,经长时间换药后乙级愈合。无死亡病例。结论经皮经肝V段胆囊穿刺外引流可简单、有效、迅速的达到减压和引流的目的,减少了胆囊坏疽、穿孔等严重并发症的发生,从而让这些特殊患者度过急性期,减少急诊手术并发症的发生。

Objective Study feasibility and effectiveness of the ultrasound guided percutaneous liver V section of gallbladder puncture drainage. Methods A retrospective analysis of our hospital from January 2008 to December 2013, 53 cases of special groups in the treatment of acute cholecystitis, including application of pereutaneous, after treatment for liver V section of gallbladder puncture drainage of 22 cases of elective surgical procedures, without puncture drainage of emergency operation in 31 cases, Compare two groups to take different treatment patients preoperative clinical data and operative time, blood loss, average length of stay, complications. Results Ereutaneous outside, by the liver V section of gallbladder puncture drainage treatment group, all patients were successful catheter in patients with symptoms such as abdominal pain, chills, fever, quickly after 1 -3 days of white blood cells are back to normal. Whole group does not appear obvious complications （bleeding, bile leakage, slip the drainage tube, etc. ）, are marked in the line 1 to 3 months cholecystectomy and cured, no deaths. Bleeding amount of emergency operation in the treatment group 50 ml to 600 ml, most gall bladder resection in 2 cases. Postoperative 1 case complicated with septic shock, respiratory function failure turn ICU after cured; Biliary fistula in 2 cases, including 1 case after drainage of the cured, 1 case was cured after reoperation （ actually right hepatic duct injury）, 4 cases were complicated with infection of incision, postoperative serie b healing after dressing change for a long time, no deaths. Conclusion Percutaneous liver V section of gallbladder puncture drainage can be simple, effective and rapid decompression and drainage, the purpose of reducing the gallbladder necrosis and perforation of the serious complications, so that these special patients through the acute phase, reduce the emergency surgery complications.