经皮经肝胆囊穿刺引流术和延期的腹腔镜胆囊切除术治疗老年急性胆囊炎  

Percutaneous transhepatic gallbladder drainage and delayed laparoscopic cholecystectomy for acute cholecystitis in the elderly

作　　者：项灿宏[1] 周雷[1] 马仁[1] 花瞻[1] 姚力[1] 王文跃[1] 

机构地区：[1]中日友好医院普外2科,北京100029

出　　处：《中国微创外科杂志》2007年第5期452-453,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评价经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGBD)和延期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗老年急性胆囊炎的价值。方法回顾分析2001年1月～2005年12月30例老年(>65岁)急性胆囊炎使用PTGBD的临床资料。均为伴有严重内科疾病和(或)保守治疗症状不缓解的患者。结果29例导管置入成功,1例因胆囊内充满结石置管未成功,行胆汁抽吸术。并发症包括导管脱落2例(1例重新插入,1例症状缓解未再插入),1例因病情加重,后改行胆囊造瘘+腹腔冲洗引流术。27例带管出院。25例PTGBD后3周拔管,2例胆囊管梗阻中1例引流管脱落,1例保留至8周后手术。28例结石性胆囊炎接受延期手术:25例LC,2例经窦道行胆道镜胆囊取石,1例伴有胆总管结石因发现有腹膜后肿物(肾上腺肿物)行开腹手术。另4例胆总管结石中,2例在LC同时行胆道镜取石,2例LC后行内镜下十二指肠乳头切开取石术。无死亡,无胆道损伤等严重并发症。结论对于急性胆囊炎的老年病人,结合使用PTGBD和延期的LC是安全和有效的。Objective To evaluate results of the protocol using percutaneous transhepatic gallbladder drainage （PTGBD） followed by delayed laparoscopic cholecystectomy （LC） in the treatment of acute cholecystitis in elderly patients. Methods We reviewed clinical data of 30 senile patients （ 〉 65 years） with acute cholecystitis treated by PTGBD in this hospital between January 2001 and December 2005. All the patients were not symptomatically relieved after conservative therapy and/or had severe accompanying co-morbidities. Results A successful tube insertion was achieved in 29 patients, whereas insertion failure was encountered in 1 patient because the gallbladder was full of stones, in which a bile aspiration was performed. The dislodgement of drainage tube occurred in 2 patients （one patient underwent a re-insertion and the other was symptomatically relieved without insertion）. Exacerbation of the condition developed in 1 patient after the treatment, and an open cholecystostomy with abdominal irrigation and drainage was performed. Twenty-seven patients were discharged from hospital with the drainage tube intact. Of them, the drainage tube was removed 3 weeks after PTGBD in 25 patients, was maintained for 8 weeks until surgery in 1 patient, and was dislodged in 1 patient. Twenty-eight patients with calculous cholecystitis underwent a delayed surgery, including LC in 25 patients, stone removal by choledochofiberscope in 2 patients, and open surgery in 1 patient because of accompanying choledocholithiasis and retroperitoneal mass （ adrenal tumor）. In another 4 patients with choledocholithiasis, an intraoperative choledochofiberscopy during LC was performed in 2 patients, and endoscopic sphincterotomy after LC was conducted in 2. No surgery related deaths or bile duct injuries occurred. Conclusions Combined use of PTGBD and delayed LC in elderly patients with acute cholecystitis is safe and effective.

关 键 词：经皮经肝胆囊穿刺引流术 腹腔镜胆囊切除术 老年急性胆囊炎 

分 类 号：R657.4[医药卫生—外科学]