超声引导下一步法行经皮经肝胆囊穿刺引流术在急性重症胆囊炎治疗中的应用

Application of ultrasound-guided one-step percutaneous transhepatic gallbladder puncture drainage in treatment of acute severe cholecystitis

目的探讨超声引导下采用一步法行经皮经肝胆囊穿刺引流术(PTGD)在急性重症胆囊炎(ASC)治疗中临床效果。方法选择2020年1月至2023年5月在安徽医科大学第二附属医院接受PTGD治疗的ASC患者30例,其中男性19例,女性11例;年龄55~78岁,平均年龄67岁;病程42~64 h,平均病程55.77 h。行PTGD,统计视觉模拟量表(VAS)评分;对临床症状缓解患者行腹腔镜下胆囊切除术(LC)。比较其术前、术后第1天胆囊长径、胆囊宽径及术前、术后第1天、术后第3天感染指标变化;分析患者术后第1天、第2天、第3天腹痛缓解率;分析患者术后并发症发生情况。结果30例患者均一次性穿刺置管成功。术后第1天、第2天、第3天患者腹痛症状缓解率分为86.7%(26/30)、96.7%(29/30)和100.0%(30/30)。其中26例患者于术后5~6周后行LC。患者术后第1天胆囊长径、胆囊宽径均较术前减小[(76.58±8.62)mm vs(105.35±14.84)mm、(28.71±5.29)mm vs(41.25±3.41)mm。P<0.05]。患者最高体温、白细胞计数(WBC)、中性粒细胞比例(NEU%)、C反应蛋白(CRP)水平及VAS评分在术后第1天、术后第3天均较术前下降,且术后第3天低于术后第1天(P<0.05)。术后出现1例发生引流管脱管,1例胆汁引流不畅,但均未出现出血、胆汁漏、血气胸等严重并发症。结论在ASC的治疗中,采用超声引导下一步法行PTGD治疗可以减轻患者疼痛,改善炎症指标,降低术后并发症的发生。

Objective To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD)in treatment of acute severe cholecystitis(ASC).Methods From January 2020 to May 2023,a total of 30 ASC patients performed PTGD were enrolled,which included 19 males and 11 females,aged 55-78 years old with mean age of 67 years old;disease course was 42-64 hours with mean course of 55.77 hours.All of them were performed PTGD,and visual analogue scale(VAS)score was counted.The laparoscopic cholecystectomy(LC)was performed in patients with remission of clinical symptoms.The changes of gallbladder length diameter,gallbladder width diameter before operation and on the 1st day after operation were compared,and the changes of infection indexes before operation,1st day after operation and 3rd day after operation were compared.The remission rate of abdominal pain on the 1st,2nd and 3rd day after operation was analyzed.The incidence of postoperative complications was analyzed.Results All of patients were successfully punctured and catheterized for the first time.The remission rate of abdominal pain symptoms on the 1st,2nd and 3r day after operation were 86.7%(26/30),96.7%(29/30)and 100.0%(30/30).Among them,26 patients underwent LC after operation 5-6 weeks.The length diameter and width diameter of gallbladder on the 1st day after operation were smaller than those before operation[(76.58±8.62)mm vs(105.35±14.84)mm,(28.71±5.29)mm vs(41.25±3.41)mm.P<0.05].The highest body temperature,white blood cell count(WBC),percentage of neutrophils(NEU%),C-reactive protein(CRP)level and VAS score on the 1st and 3rd day after operation were lower than those before operation,and the 3rd day after operation was lower than that on the 1st day after operation(P<0.05).After oper ation,1 case showed drainage tube detachment and 1 case with poor bile drainage,but there was no serious complications such as bleeding,bile leakage and hemopneumothorax occurred.Conclusion It is demonstrated that ultrasound-guided one-step PTGD could alleviate suffering,improve inflammation indicators and reduce postoperative complications in treatment of ASC.