超声引导下经皮肝穿刺胆囊置管引流治疗急性重症胆源性胰腺炎的临床应用  

Clinical research on ultrasound guided percutaneous transhepatic gallbladder drainage for patients with severe acute biliary pancreatitis

作　　者：沈光贵[1] 姜小敢[1] 鲁卫华[1] 金孝岠[1] 吴敬医[1] 王箴[1] 王涛[1] 

机构地区：[1]皖南医学院附属弋矶山医院重症医学科

出　　处：《皖南医学院学报》2013年第6期460-462,465,共4页Journal of Wannan Medical College

摘　　要：目的:评价应用超声引导下经皮肝穿刺胆囊置管引流治疗急性重症胆源性胰腺炎的临床效果,并观察并发症发生情况。方法:采用回顾性研究方法,收集皖南医学院附属弋矶山医院重症医学科自2010年12月～2013年7月应用超声引导下经皮肝穿刺胆囊置管引流术治疗急性重症胆源性胰腺炎患者23例临床资料,分别于穿刺前、穿刺后第3天比较患者临床症状(腹痛、腹胀、恶心、发热、呼吸困难)及各项指标变化(白细胞、降钙素原、C-反应蛋白、淀粉酶、脂肪酶、转氨酶、胆红素、APACHEⅡ评分、Balthazar CT评分、MODS评分),并观察并发症发生情况(出血、胆漏、肠道损伤、导管易位,导管滑脱)。结果:23例患者中成功实施经皮肝穿刺胆囊置管引流术21例(91.3%)。与治疗前比较,患者治疗后第3天临床症状均明显缓解,大部分生化指标及危重病相关评分均明显下降(P<0.05),而谷丙转氨酶变化差异无统计学意义(P>0.05)。有2例患者因穿刺后出血导致穿刺失败,1例经积极止血输血治疗后出血停止,另1例经外科手术止血。所有患者中发生胆漏1例(4.8%),经积极引流治疗后缓解;发生导管易位引流不畅2例(9.5%);发生非计划拔管1例(4.8%),后改为手术治疗;未发生肠道损伤并发症。结论:应用超声引导下经皮肝穿刺胆囊置管引流治疗急性重症胆源性胰腺炎可有效缓解患者临床症状,改善临床指标及相关危重病评分,具有一定的疗效优势。Objective：To observe the clinical efficacy and complications of endoscopic ultrasound guided percutaneous transhepatic gallbladder drainage （ PTGD ） for patients with severe acute biliary pancreatitis . Methods： The clinical date were retrospectively examined in 23 cases of severe acute biliary pancreatitis undergone PTGD between December 2010 and July 2013 in our department.The total cases were compared regarding the clinical symptoms（ abdominal pain,abdominal distention,nausea,body temperature and dyspnea） at the 3rd day before and after the procedure and changes of biochemical indicators, including white blood cell （ WBC ） , procalcitonin （ PCT ） , c-reactive protein （ CRP ） , amylase （AMY）,lipase（LPS）,glutamate-pyruvate transaminase（GPT）,total bili-rubin（T-Bil）as well as prognostic scores of Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ）,CT severity index（Balthazar score）and Multiple organ dysfunction syndrome（MODS）,respectively,and observed with the postoperative complications （ bleeding, biliary leakage, intestinal injury and catheter dislocation and detachment ） .Results：Successful PT-GD in 21 of the 23 cases（91.3%） resulted in evident relief of clinical symptoms and down-regulation of the biochemical indexes and prognostic scores described above（P0.05）,as compared with those re-corded at the 3rd day before intervention.Failure in 2 cases due to bleed-ing after applying the catheter was managed with hemostasis by either blood transfusion or surgical intervention.Additionally,biliary leakage oc-curred in 1 case（4.8%）who was treated with subsequent active drainage and inadequate drainage due to catheter dislocation in 2（9.5%）.Another 1 case required early catheter removal and was referred to surgical man-agement.There was no incidence of intestinal injury for the total cases . Conclusion： Ultransound guided PTGD for patients with severe acute bil-iary pancreatitis may be preferable,for the technique can lead to effective�

关 键 词：急性胰腺炎 重症 超声引导 经皮肝穿刺胆囊置管引流 治疗 

分 类 号：R657.51[医药卫生—外科学]