经皮经肝胆囊穿刺置管引流术治疗急性化脓性胆囊炎21例

Application of percutaneous transhepatic gallbladder drainage in treating 21 patients with acute suppurative cholecystitis

目的评价在DSA设备引导下经皮经肝胆囊穿刺置管引流术治疗急性化脓性胆囊炎的疗效及应用价值。方法回顾性分析南京医科大学附属南京江宁医院2015年4月至2018年12月通过经皮经肝胆囊穿刺置管引流术治疗的21例急性化脓性胆囊炎患者的临床资料。观察并记录患者治疗前后临床症状及相关实验室检查和治疗结果。结果所有患者均一次性置管成功,经皮经肝胆囊穿刺置管引流术治疗前后的白细胞计数[(10.81±7.11)×10^9对(7.27±3.54)×10^9]、体温[(38.3±0.6)℃对(37.3±0.3)℃]及疼痛评分[(6.00±1.30)对(4.79±0.89)]差异均有统计学意义(P均<0.05)。其中19例患者在3 d内腹痛症状缓解,腹部体征减轻或消失;6例患者好转后行二期外科手术。置管后1例患者出现感染加重,1例患者出现感染性休克,1例患者拔管后出现胆汁漏。结论对于急性化脓性胆囊炎采用经皮经肝胆囊穿刺置管引流术是一种安全有效的治疗方案。操作简单、并发症少,能明显缓解症状,可为二期外科手术提供条件,值得临床推广应用。

Objective To evaluate the curative effect and application value of DSA-guided percutaneous transhepatic gallbladder drainage(PTGD)in treating acute suppurative cholecystitis.Methods The clinical data of 21 patients with acute suppurative cholecystitis,who were admitted to the Affiliated Nanjing Jiangning Hospital of Nanjing Medical University of China during the period from April 2015 to December 2018 to receive DSA-guided PTGD treatment,were retrospectively analyzed.The preoperative and postoperative clinical symptoms and the related laboratory results were recorded,and the therapeutic outcomes were evaluated.Results The implantation of PTGD catheter was successfully accomplished with single procedure in all patients.The preoperative and postoperative white blood cell count was(10.81±7.11)×10~3 and(7.27±3.54)×10~3 respectively,the temperature was(38.3±0.6)℃and(37.3±0.3)℃respectively,and the visual analog scale(VAS)score of abdominal pain was(6.00±1.30)points and(4.79±0.89)points respectively,the differences in all the above indexes were statistically significant(P<0.05 in all).The symptoms of abdominal pain and the abdominal signs were relieved or disappeared in 19 patients within 3 days.Second-stage surgery was employed in 6 patients after their clinical condition was improved.After the implantation of PTGD catheter,the infection was aggravated in one patient,infectious shock occurred in one patient,and one patient developed bile leakage after retrieval of drainage catheter.Conclusion For acute suppurative cholecystitis,PTGD is a safe and effective treatment.It is technically simple with less complications,and it can remarkably relieve the clinical symptoms.PTGD can create necessary conditions for second-stage surgery.Therefore,this therapy is worthy of clinical application.