经皮经肝胆囊穿刺引流术在急性非结石性胆囊炎治疗中的价值

The value of percutaneous transhepatic gallbladder drainage in the treatment of acute non-stony cholecystitis

目的:比较单纯经皮经肝胆囊穿刺引流术和经皮经肝胆囊穿刺引流术联合胆囊切除术两种方法治疗急性非结石性胆囊炎的临床疗效。方法:选取2015年1月至2018年1月山西医科大学第一医院收治的31例急性非结石性胆囊炎患者,分为2组,A组14例,行单纯胆囊穿刺引流术,2~4周后拔除引流管;B组17例,行胆囊穿刺引流术后2~4周行胆囊切除术。比较两组患者的成功率、住院时间、复发率以及并发症发生率。结果:31例患者均一次性穿刺成功,患者的感染及腹痛症状在10h后明显减轻。B组的住院时间比A组长[(13±4)dvs.(5±2)d],差异有统计学意义(t=3.250,P<0.05)。A组有1例在拔除引流管后4周再次高热,轻度腹痛,考虑胆囊炎复发,但是症状较轻,给予抗感染治疗后治愈。B组术后1例出现下肢静脉血栓,1例出现切口感染,1例出现肺部感染,两组的复发率和并发症发生率差异无统计学意义。结论:对于不伴有胆囊或者胆管结石的急性胆囊炎患者,单纯的经皮经肝胆囊穿刺引流和经皮经肝胆囊穿刺引流联合胆囊切除术都是有效安全的治疗方法,但是单纯经皮经肝胆囊穿刺引流术的住院时间较短。

Objective: To compare the clinical efficacy of simple percutaneous transhepatic gallbladder drainage and percutaneous transhepatic gallbladder drainage combined with cholecystectomy on acute non-stone cholecystitis. Methods: Thirty-one patients were selected, examined by ultrasound and CT before surgery and then divided into 2 groups. The patients in group A(14 cases) underwent gallbladder puncture and drainage first, and after 2-4 weeks drainage tube was extracted;17 patients in group B underwent gallbladder puncture and drainage first, and underwent cholecystectomy after 2-4 weeks. The success rate, length of hospitalization, relapse rate and complication rate of the two groups were compared. Results: All patients were successfully punctured once, and the symptoms of infection and abdominal pain were significantly reduced after 10 h. The hospitalization time of groups A and B was(5±2) d and(13±4) d, the difference was statistically significant(P<0.05), the relapse rates of two groups were 7.1% in group A and 0% in group B(P>0.05), the difference was not statistically significant, the complication rates in two groups were 0% in group A and 17.6% in group B(P>0.05), without statistically significant difference. Conclusions: Simple percutaneous transhepatic gallbladder drainage and percutaneous transhepatic gallbladder drainage combined with cholecystectomy are effective and safe methods for patients with acute cholecystitis without gallbladder or bile duct stones, and the length of hospitalization of patients under simple percutaneous transhepatic gallbladder drainage is shorter.