经皮经肝胆囊穿刺引流术治疗急性胆囊炎的研究进展

Research Progress of Percutaneous Transhepatic Gallbladder Drainage in the Treatment of Acute Cholecystitis

急性胆囊炎(acute cholecystitis,AC)是常见的急腹症之一。近年来,随着微创技术的进步和外科医师腹腔镜水平的提升,腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)已成为治疗急性胆囊炎的金标准,因其创伤小、操作简单、术后恢复快而备受推崇。但对于高龄、合并严重基础疾病的高危患者而言,急诊行LC存在着较高的手术风险。超声引导下经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGBD)能够有效减轻胆囊压力、迅速缓解感染症状,目前已逐渐成为有手术禁忌的患者首选的治疗措施。然而关于急性胆囊炎PTGBD的适应证、禁忌证、术后LC手术时机及术后拔管时机的选择存在着颇多的争议,本综述将就此做一文献总结,以供临床参考。

Acute cholecystitis(AC)is one of the common acute abdominal diseases.In recent years,with the advancement of minimally invasive technology and the improvement of surgeons'laparoscopic skills,laparoscopic cholecystectomy(LC)has become the gold standard in the treatment of acute cholecystitis,and it is highly respected for its less traumatic,simpler operation,and quicker postoperative recovery.However,for high-risk patients of advanced age with comorbid severe underlying disease,emergency LC carries high surgical risks.Ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGBD)can effectively reduce the pressure on the gallbladder and rapidly alleviate the symptoms of infection,and has gradually become the first choice for patients with contraindications to surgery.However,there is considerable controversy regarding the indications,contraindications,timing of postoperative LC surgery and postoperative extubation time for PTGBD in acute cholecystitis,and this review will summarize the literature for clinical reference.