彩超引导下经皮经肝胆囊穿刺置管引流治疗41例高危人群急性胆囊炎

Treatment of acute cholecystitis in 41 high-risk patients by percutaneous transhepatic gallbladder drainage guided by ultrasound

目的评价彩超引导下经皮经肝胆囊穿刺引流(PTGBD)治疗高危人群急性胆囊炎的价值。方法回顾性分析从2014年3月至2017年4月江门市中心医院肝胆外科41例高危人群急性胆囊炎临床资料。结果所有患者均顺利完成PTGBD,术后2例出现胆道出血,经保守治疗后治愈,无胆漏、穿孔等并发症发生,无死亡病例。3例患者院外出现导管脱落,因症状好转,患者不同意手术而未进一步治疗;3例因心肺功能无法耐受手术、6例因患者不同意手术拔除引流管。以上病例随访6~24月未见胆囊炎急性发作。29例顺利接受LC术,无中转开腹病例。PTGBD后2周~3月施行LC,平均手术时间74.9±67.3 min,术中出血约7.2±9.2 m L,术后住院时间2.6±2.1天,术后有1例出现腹腔出血,经保守治疗后治愈出院,无胆道出血、胆道损伤、胆漏等术后并发症发生。胆囊壁厚度与LC时间呈正相关,相关系数为0.455(P=0.013)。结论彩超引导下PTGBD可有效控制胆囊急性炎症,为后续施行腹腔镜下胆囊切除术创造条件。

Objective To evaluation of percutaneous transhepatic gallbladder drainage(PTGBD)guided by color doppler ultrasound for the treatment of high-risk groups for acute cholecystitis.Methods The clinical data of 41 high-risk patients with acute cholecystitis were analyzed retrospectively from March 2014 to April 2017. Results All patients were successfully completed the PTGBD. There were two cases of biliary hemorrhage,and cured after conservative treatment. No gall leakage,perforation and other complications occurred. Three patients had catheter dislocation,who did not agree to the operation without further treatment due to the improvement of the symptoms. Three patients were unable to tolerate surgery due to cardiopulmonary function,and six cases patients did not agree with the surgical and removed drainage tube. The above cases were followed up for six to 24 months without acute cholecystitis. Twenty-nine cases were successfully underwent by LC,and no case was underwent laparotomy.LC came two weeks to three months after PTGBD. The operation time was 74.9±67.3 min,the intraoperative hemorrhage was 7.2 ± 9.2 ml,and the postoperative hospitalization time was 2.6 ±2.1 days. One cases of abdominal bleeding was found and cured after conservative treatment. The thickness of gallbladder wall was positively correlated with LC time,and the correlation coefficient was 0.455. Conclusion Our results confirmed that PTGBD should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis.