控制损伤外科理念指导PTCD治疗老年急性重症胆管炎的临床分析  

Application of damage control surgery-guided PTCD in the treatment of severely acute cholangitis after Biliary-enteric anastomosis

作　　者：刘颜良[1] 张智勇[1] 蔡逊[1] 

机构地区：[1]广州军区武汉总医院普通外科,武汉430070

出　　处：《腹部外科》2016年第4期297-299,303,共4页Journal of Abdominal Surgery

摘　　要：目的 探讨控制损伤外科（damage control surgery,D（S）理念指导超声引导下行经皮经肝胆道穿刺引流术（percutaneous transhepatic cholangial drainage,PTCD）的临床价值.方法 回顾分析2010年10月至2014年10月期间治疗118例老年急性重症胆管炎病人,其中男性65例,女性53例;年龄65～87岁,平均年龄（68.15±9.13）岁.同期急性胆管炎病例数384例,老年急性重症胆管炎占23％.既往均有不同程度胆道感染史,其中病史时间＜10年病人56例,11～20年病人49例,病史时间＞20年病人13例.病人伴有1种或多种内科基础疾病,包括高血压、冠心病、糖尿病、慢性阻塞性肺疾病68例.一期均无法耐受急诊手术治疗,选择超声引导下行PTCD治疗.结果 118例均获穿刺成功,除1例病人穿刺导管出院后不慎滑脱外,其余病人均无胆道出血、胆汁性腹膜炎等并发症,83例病人因肝外胆管结石、肝内胆管结石、肝左叶萎缩行胆总管探查T管引流术、肝部分切除术,术后随访6个月无胆管炎发作.17例病人因胆肠吻合口狭窄再次行Roux-en-Y胆肠吻合术,1例病人穿刺置管成功后顺利出院,出院后2d穿刺导管不慎滑脱,及时返院行手术治疗,术后随访6个月均恢复顺利.17例病人因晚期肿瘤无法行手术治疗,带管出院3～6个月后死亡.结论 以DCS理念为指导,PTCD相对外科手术创伤小、治疗效果确切,操作简单、迅速,具有微创特点.针对老年急性重症胆管炎合并心肺基础疾病无法耐受手术病人,可作为急救措施,为择期根治性治疗赢得机会.Objective To summarize the application of damage control surgery （DCS）-guided percutaneous transhepatic cholangiography and drainage （PTCD）. Methods The clinical data of 118 patients who received ultrasound-guided PTCD for severely acute cholangitis after Biliary-enteric anas- tomosis when their general conditions couldn＇t tolerate the surgical treatment were retrospectively stud- ied. Results All 118 cases were punctured successfully without complications such as biliary bleeding, bile peritonitis except that 1 case with puncture catheter accidentally slipped after hospital discharge. There were good effects of antimicrobial therapy according to the drug sensitive test of bile culture, such as the relief of high fever, jaundice, and liver function. Conclusions DCS can break down the risk of surgery. PTCD was a safe and efficacious procedure. It was more likely to be helpful for patients who were in a serious condition with severely acute cholangitis after complex biliary surgery, cardiop- ulmonary diseases or aged, as it was minimally invasive and tolerated. It was a good preparatory pro- cedure before conventional surgery.

关 键 词：控制损伤外科 超声引导 经皮经肝胆道穿刺引流术 

分 类 号：R657.4[医药卫生—外科学]