超声引导下经皮胆囊穿刺双管引流联合胆道镜治疗急性结石性胆囊炎高危患者  

Ultrasound-guided Percutaneous Gallbladder Double-catheter Drainage Combined with Choledochoscope for High-risk Acute Calculous Cholecystitis

作　　者：向珂[1] 程龙[1] 骆助林[1] 田伏洲[1] 汤礼军[1] 陈涛[1] 陈琪[1] 刘丹青[1] 

机构地区：[1]成都军区总医院全军普通外科中心,成都610083

出　　处：《中国微创外科杂志》2015年第2期146-148,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：四川省卫生厅科研课题(编号110467)

摘　　要：目的探讨超声引导下经皮胆囊穿刺双管引流联合胆道镜治疗急性结石性胆囊炎高危患者的可行性及应用价值。方法回顾性分析2012年6月~2013年12月急性结石性胆囊炎高危患者24例的临床资料。合并高血压6例,心绞痛4例,心力衰竭2例,急性心肌梗死介入术后1例,慢性阻塞性肺病5例,糖尿病5例,慢性肾功能衰竭1例。美国麻醉师协会（American Society of Anesthesiologists,ASA）分级,Ⅲ级11例,Ⅳ级13例。行超声引导下经皮经肝胆囊穿刺引流,抽尽胆汁,注入生理盐水使胆囊充盈,再于右侧肋缘下穿刺胆囊,双管引流,1周后扩张窦道,行胆道镜取石。结果所有患者穿刺引流后症状及体征缓解,均胆道镜取净胆囊结石,无胆漏、肠漏、出血等严重并发症发生。21例随访6~24个月,（11.1±6.1）月。1例胆囊结石复发。结论该方法治疗高危急性结石性胆囊炎患者安全有效,具有临床应用价值。Objective To investigate the feasibility and value of ultrasound-guided percutaneous gallbladder double-catheter drainage combined with choledochoscope in high-risk acute calculous cholecystitis patients. Methods Clinical data of 24 high-risk acute calculous cholecystitis patients admitted from June 2012 to December 2013 were retrospectively analyzed. Among them,there were 6 cases of hypertension,4 cases of angina pectoris,2 cases of heart failure,1 case of interventional operation for acute myocardial infarction,5 cases of chronic obstructive pulmonary disease,5 cases of diabetes mellitus,and 1 case of chronic renal failure.According to the American Society of Anesthesiologists（ ASA） classification,there were 11 cases of grade Ⅲ and 13 cases of gradeⅣ. Under the guidance of ultrasound,percutaneous transhepatic gallbladder drainage was performed to remove the bile and then the gallbladder was filled with saline. Afterwards the gallbladder was catheterized again blow the right costal margin. The bile was drained out with two catheters and stones were removed with choledochoscope after expansion the sinus tracts 1 week later. Results All the patients were alleviated of symptoms and signs after drainage and all the stones were removed by choledochoscope. There were no serious complications,such as biliary fistula,intestinal fistula,or bleeding. Twenty-one cases were followed up for 6- 24 months,with an average of 11. 1 ± 6. 1 months. Gallbladder stone recurrence was seen in 1 case. Conclusion This method was safe and effective and has great clinical value in high-risk patients with acute calculous cholecystitis.

关 键 词：超声引导 经皮胆囊穿刺双管引流 胆道镜 急性结石性胆囊炎 

分 类 号：R575.61[医药卫生—消化系统]