超声引导下胆囊穿刺引流术治疗老年急性高危胆囊炎

Effect of ultrasound-guided percutaneous transhepatic gallbladder drainage in treatment of elderly patients with acute high-risk cholecystitis

目的探讨超声引导下胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGBD)治疗老年急性高危胆囊炎的疗效。方法回顾性分析2016年1月至2020年1月浙江省台州市立医院肝胆外科收住的67例老年急性高危胆囊炎行PTGBD的临床资料,比较PTGBD术前术后的疼痛评分、体温、白细胞计数、CRP水平、肝功能、CA199水平,分析PTGBD术后并发症、胆汁培养及进一步治疗情况。结果67例老年急性高危胆囊炎患者均顺利完成PTGBD术。与术前比较,PTGBD术后患者疼痛评分、体温、白细胞计数、CRP、总胆红素、谷丙转氨酶、谷草转氨酶、CA199水平均明显下降(P<0.01)。PTGBD术后出现并发症7例,其中出血4例,拔管后出现胆瘘3例。胆汁细菌培养阳性33例,其中大肠杆菌19例,肺炎克雷伯菌9例,粪肠球菌3例,铜绿假单胞菌2例。PTGBD术后进一步治疗情况:67例中27例于PTGBD术后1周内行腹腔镜胆囊切除术(LC),19例于PTGBD术后1~3个月行LC手术,16例因症状缓解拒绝行进一步手术治疗,5例失访。结论对于老年急性高危胆囊炎患者行PTGBD安全有效,不适合急诊手术的患者近期可获得有效缓解。

Objective To investigate the effect of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of elderly patients with acute high-risk cholecystitis.Methods The clinical data of 67 elderly patients with acute high-risk cholecystitis admitted in Taizhou Municipal Hospital between Jan.2016 and Jan.2020 were analyzed retrospectively.All patients received PTGBD.The pain score,body temperature,leukocyte count,CRP level,liver function,CA199 level,postoperative complications,bile culture and further treatment after PTGBD were compared before and after PTGBD.Results All 67 patients successfully completed PTGBD.After PTGBD,the pain score,body temperature,white blood cell count,CRP level,total bilirubin,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase and CA199 level were significantly decreased(P<0.01).Complications occurred in 7 cases,of which bleeding in 4 cases and biliary fistula in 3 cases after extubation.Among 67 patients,33 cases of bile bacteria culture were positive:19 cases of Escherichia coli,9 cases of Klebsiella pneumoniae,3 cases of Enterococcus faecalis and 2 cases of Pseudomonas aeruginosa.After PTGBD procedure,among 67 cases,27 received further laparoscopic cholecystectomy(LC)within 1 week,19 received LC within 1~3 months,16 refused further surgery because of symptom relief and 5 lost follow-up.Conclusion PTGBD is safe and effective for elderly patients with acute high-risk cholecystitis,and short-term effective relief can be obtained for patients unsuitable for emergency operation.