急性胆囊炎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,...急性胆囊炎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。本文对PTGBD的现状和问题进行综述,并对其未来前景进行讨论。Acute cholecystitis is one of the common acute abdominal diseases. In recent years, with the advancement of minimally invasive technology and the improvement of surgeons’ laparoscopic level, laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis, which is highly respected because of its small trauma, simple operation, and fast postoperative recovery. However, for high-risk patients of advanced age and combined with severe underlying diseases, there is a high surgical risk of performing LC in emergency. Ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) can effectively reduce gallbladder pressure and rapidly alleviate the symptoms of infection, and has gradually become the preferred therapeutic measure for patients with contraindications to surgery. This article reviews the current status and problems of PTGBD and discusses its future prospects.展开更多
目的探讨经皮经肝胆囊穿刺引流(PTGBD)联合腹腔镜胆囊切除术(LC)治疗对急性胆囊炎患者围术期相关指标、术后疼痛程度及肝功能指标的影响,为提升该疾病的临床治疗效果提供依据。方法选取湖北省中医院2021年1月至2023年1月收治的70例急性...目的探讨经皮经肝胆囊穿刺引流(PTGBD)联合腹腔镜胆囊切除术(LC)治疗对急性胆囊炎患者围术期相关指标、术后疼痛程度及肝功能指标的影响,为提升该疾病的临床治疗效果提供依据。方法选取湖北省中医院2021年1月至2023年1月收治的70例急性胆囊炎患者,根据随机数字表法分为对照组(35例)和观察组(35例)。对照组患者行LC治疗,观察组患者在行LC前先行PTGBD治疗,术后均对两组患者进行3个月的随访。比较两组患者围术期相关指标,术后不同时间的视觉模拟量表(VAS)疼痛评分,治疗前后肝功能指标,以及并发症的发生情况。结果观察组患者手术时间、LC术后首次肛门排气时间和腹腔引流时间均较对照组短,术中失血量较对照组少;观察组患者术后12、24、48 h VAS疼痛评分均低于对照组;与术前比,术后24 h两组患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、淀粉酶(AMY)、总胆红素(TBiL)、间接胆红素(IBiL)水平均降低,且观察组相比于对照组更低;观察组患者并发症总发生率低于对照组(均P<0.05)。结论PTGBD联合LC对急性胆囊炎患者创伤小,与单纯行LC治疗相比患者术后疼痛感轻,可有效改善患者肝功能,促进患者预后快速恢复,减少术后并发症的发生。展开更多
文摘急性胆囊炎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。本文对PTGBD的现状和问题进行综述,并对其未来前景进行讨论。Acute cholecystitis is one of the common acute abdominal diseases. In recent years, with the advancement of minimally invasive technology and the improvement of surgeons’ laparoscopic level, laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis, which is highly respected because of its small trauma, simple operation, and fast postoperative recovery. However, for high-risk patients of advanced age and combined with severe underlying diseases, there is a high surgical risk of performing LC in emergency. Ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) can effectively reduce gallbladder pressure and rapidly alleviate the symptoms of infection, and has gradually become the preferred therapeutic measure for patients with contraindications to surgery. This article reviews the current status and problems of PTGBD and discusses its future prospects.
文摘目的探讨经皮经肝胆囊穿刺引流(PTGBD)联合腹腔镜胆囊切除术(LC)治疗对急性胆囊炎患者围术期相关指标、术后疼痛程度及肝功能指标的影响,为提升该疾病的临床治疗效果提供依据。方法选取湖北省中医院2021年1月至2023年1月收治的70例急性胆囊炎患者,根据随机数字表法分为对照组(35例)和观察组(35例)。对照组患者行LC治疗,观察组患者在行LC前先行PTGBD治疗,术后均对两组患者进行3个月的随访。比较两组患者围术期相关指标,术后不同时间的视觉模拟量表(VAS)疼痛评分,治疗前后肝功能指标,以及并发症的发生情况。结果观察组患者手术时间、LC术后首次肛门排气时间和腹腔引流时间均较对照组短,术中失血量较对照组少;观察组患者术后12、24、48 h VAS疼痛评分均低于对照组;与术前比,术后24 h两组患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、淀粉酶(AMY)、总胆红素(TBiL)、间接胆红素(IBiL)水平均降低,且观察组相比于对照组更低;观察组患者并发症总发生率低于对照组(均P<0.05)。结论PTGBD联合LC对急性胆囊炎患者创伤小,与单纯行LC治疗相比患者术后疼痛感轻,可有效改善患者肝功能,促进患者预后快速恢复,减少术后并发症的发生。