彩超引导下经皮经肝胆囊穿刺引流置管术对高龄重症胆囊炎的应用价值

The application value of color ultrasound-guided percutaneous transhepatic gallbladder drainage for severe cholecystitis in elderly patients

目的探讨彩超引导下经皮经肝胆囊穿刺引流置管术(PTGBD)对高龄重症胆囊炎的应用价值。方法回顾性分析2015-01~2018-06该院住院64例高龄重症胆囊炎患者的临床资料。其中34例患者在内科治疗基础上加用彩超引导下给予PTGBD治疗(PTGBD组),30例给予内科保守治疗(对照组)。比较两组治疗前后体温、腹痛评分及白细胞计数、血沉、超敏C反应蛋白、降钙素原、γ-谷氨酰转肽酶、总胆红素、直接胆红素变化,住院时间和住院费用等各项指标。结果与对照组比较,PTGBD组患者住院时间明显缩短,住院费用降低(P <0. 05)。PTGBD组术后72 h以内体温降至正常,腹痛明显好转,1周内白细胞计数、血沉、超敏C反应蛋白、降钙素原、γ-谷氨酰转肽酶、总胆红素、直接胆红素、国际标准化比值明显下降,与术前比较差异有统计学意义(P <0. 05)。结论经彩超引导下PTGBD治疗,创伤小,能快速减轻胆囊内压力,预防脓毒血症。对于存在手术禁忌证的高龄重症胆囊炎患者具有较好的应用价值。

Objective To explore the application value of color ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGBD)for severe cholecystitis in elderly patients.Methods The clinical data of 64 elderly patients with severe cholecystitis in our hospital from January 2015 to June 2018 were analyzed retrospectively.Of the 64 elderly patients,34 cases were treated with PTGBD under color Doppler ultrasound guidance on the basis of medical treatment(PTGBD group),and 30 cases were given conservative treatment(control group).The changes of body temperature,abdominal pain score and white blood cell count,erythrocyte sedimentation rate,hypersensitive C-reactive protein,procalcitonin,gamma-glutamyl transpeptidase,total bilirubin,direct bilirubin,hospitalization time and hospitalization costs were statistically analyzed and compared before and after PTGBD treatment between the two groups.Results Compared with those in the control group,the patients in PTGBD group had shorter hospitalization time and less hospitalization costs(P<0.05).The body temperature of the patients in PTGBD group dropped to normal within 72 hours after operation,and the abdominal pain improved significantly.Leukocyte count,erythrocyte sedimentation rate,hypersensitive C-reactive protein,procalcitonin,gamma-glutamyl transpeptidase,total bilirubin,direct bilirubin,and international standardized ratio in the patients in PTGBD group after treatment were reduced significantly within one week and the differences were statistically significant compared with those before treatment(P<0.05).Conclusion Color ultrasound-guided PTGBD has the advantages of minimal wounding.It can quickly reduce the pressure inside the gallbladder and prevent sepsis and has a high application value for elderly patients with severe cholecystitis who have surgery contraindication.