118例经皮胆囊穿刺治疗危急重症胆囊炎及序贯治疗和预后分析  

The sequential therapy after percutaneons cholecystostomy in the treatment of acute cholecystitis in 118 poor risk patients and prognostic analysis

作　　者：赵中海[1] 朱立东[1] 杨景国[1] 汪威[1] 陈哲[1] 韩樱松[1] 李宁[1] 夏峰[2] 

机构地区：[1]北京市普仁医院普外科,北京100062 [2]北京同仁医院普外科,北京100730

出　　处：《中国医刊》2016年第6期64-66,共3页Chinese Journal of Medicine

摘　　要：目的探讨经皮胆囊穿刺引流治疗危急重症胆囊炎的疗效以及后续序贯治疗方案选择。方法回顾性分析2010年1月至2015年12月北京市普仁医院收治的118例危急重症胆囊炎行胆囊穿刺引流患者的临床资料,总结患者穿刺后恢复、后续的胆囊切除手术方式、序贯治疗以及患者预后情况。结果 118例行胆囊穿刺治疗,102例患者病情好转后出院,死亡16例;后续行胆囊切除术83例,7例非结石性胆囊炎,好转后拔除胆囊引流,12例评估后仍无法耐受麻醉及手术,长期带管。16例患者首次穿刺期间死亡,死亡原因主要为心肺功能不全,其中80岁以上并发症严重患者占75%。结论经皮肝穿胆囊引流是一种相对安全有效的方法,但是对于一些高龄患者即使行穿刺治疗,因全身情况复杂,术后恢复仍有较大风险,胆囊穿刺后续治疗应针对发病的不同特点及全身状况做好评估,做出更适宜的治疗方案。Objective To evaluate the effects, sequential therapy and prognostic analysis of percutaneous cholecystostomy（PCT） for the treatment of acute cholecystitis in the older or poor-risk patients. Method A retrospective clinical analysis was undertaken in the older or poor-risk patients receiving PCT from January 2010 to December 2015. Further therapy was included of cholecystectomy, perpetual PCT drainage and remove of PCT drainage. The morbidity and morbidity rate was analyzed. Result The study included 118 patients accepting PCT. Hospital discharge was 102 cases after persistent PCT drainage. The patterns of sequential therapy was 83 cases of Cholecystectomy, 12 cases of perpetual PCT drainage and 7 cases of remove of PCT drainage with acalculous cholecystitis.16 cases was died after PCT drainage and 75% was over 80 years of ages. Conclusion PCT is considered relatively safe and cost effective for the management of acute cholecystitis in the older or poor-risk patients, but in some patients over 80 years of ages the prognostic is poor because of significant comorbidities. The patterns of sequential therapy was decided after evaluating the aetiologic agent of acute cholecystitis and systemic disease of the patients.

关 键 词：胆囊炎 急性 经皮胆囊造口术 预后 

分 类 号：R575.61[医药卫生—消化系统]