胆囊化学灭活的临床应用和远期疗效观察

Clinical application of chemical ablation of gallbladder and the long - term observation of its effect

目的 探讨胆囊化学灭活的临床应用可行性和远期疗效。方法 胆羹造瘘２１人，微波热凝闭塞胆囊管后，向胆囊内注入９５％酒精灭活胆囊粘膜，１次／４小时，连续６次。如灭活１周后造影胆囊腔闭合，胆囊管不显影；或引流量＜１０ｍｌ，无胆汁，则为灭活成功。灭活前后分别测定血肝肾功能指标和心电图。结果１次微波热凝闭塞胆囊管的成功率为７６％（１６／２１），２次为９５％（１９／２０）；９５％酒粗完全灭活胆囊粘膜的成功率为８５％（１７／２０），另３例灭活后胆囊区仍有小的液性暗区。所有病人无结石再生，灭活中及灭活后无严重并发症。灭活前后血生化和ＥＣＧ无明显变化（Ｐ＞０．０５）。结论 胆囊化学灭活临床应用安全有效，远期疗效满意。

Objective To study clinical application and the long - term effect of chemical ablation of gall- bladder. Methods 21 patients with cholecystostomy unelerwent gallbladder ablation. First, the cystic duct was oc- cluded by microwave thermocoagulation. And then, 95% ethanol was injected into the gallbladder through a drainage tube, 4 - hourly for 6 times. Finally, if the lumen of the gallbladder was occluded and the cystic duct was not found by cholecystography; or the volume of the drainage was less than 10 ml, and no bile, gallbladder ablation was suc- cessful. Blood biochemistry and ECG were examined before and after gallbladder ablation. Results Successful rate of occluding cystic duct with microwave thermocoagulation at first time was 76% (16/21 ), and that of second time was 95% (19/20); the rate of completely abating gallbladder mucosa was 85 % (17/20),but the 3 others were uncom- plete. All of the patients had no stone recurrence, and no severe complications were found. There was no significant change in blood biochemistry and ECG between pre - and postoperaion of gallbladder ablation(P > 0 .05 ). Conclusion Chemical ablation of gallbladder was a effective and safe method, and its long - term effect was satisfactory.