选择性经皮经肝胆囊穿刺置管引流在急危重症胆管炎患者中的临床应用  

Clinical application of selective percutaneous transpepatic gallbladder dramage in patients with acute critical obstructive suppurative cholangitis

作　　者：李磊[1] 牛万成[1] 栾智勇[2] 周峰[1] 张召辉[1] 

机构地区：[1]中国人民解放军第97医院普通外科,江苏徐州221004 [2]中国人民解放军第97医院特诊科,江苏徐州221004

出　　处：《临床医药文献电子杂志》2016年第35期6917-6919,共3页Electronic Journal of Clinical Medical Literature

摘　　要：目的 观察彩超引导下经皮经肝胆囊穿刺引流（Percutaneous transpepatic gallbladder dramage,PTGD）治疗急危重症胆管炎的疗效.方法 选取我院2012年1月-2015年12月收治的不能耐受手术的急危重症胆管炎患者41例,入院后行PTGD治疗,检测患者穿刺前后相关指标.结果 41例患者均穿刺置管成功,穿刺引流48 h及72 h复查血白细胞、胆红素、谷丙转氨酶、疼痛视觉模拟评分（VAS）显著下降,差异有统计学意义（P〈0.05）,胆囊大小、胆囊壁厚度及胆总管宽度均显著缩小,差异有统计学意义（P〈0.05）.穿刺术后发生引流管堵塞l例,引流管滑脱l例,无出血及胆瘘等并发症.穿刺术后39例进一步手术或经ERCP治疗后治愈出院,另有2例带管出院.结论 对手术风险大的急危重症胆管炎患者,PTGD是一种微创、安全、可靠的治疗方法 .Objective To investigate the clinical value of percutaneous transpepatic gallbladder dramage （PTGD） in patients with acute critical obstructive suppurative cholangitis.Methods 41 patients with acute critical obstructive suppurative cholangitis in our hospital who were treated with PTGD from 2012 January to 2015 December were analysed retrospectively.Results 41 patients were all successful in operating.The abdominal pain were improved and the temperature were back to normal after operating.The WBC TBIL ALT and VAS value count descended obviously after 48 and 72 hours （P〈0.05）.The volume of gallbladder, the thickness of gallbladder wall,and the width of common bile duct were all significantly descended （P〈0.05）.39 patients were healed after further operation or ERCP, and 2 patients were left with PTGD pipe.Conclusion PTGD is an minimally invasive,safe and reliable method in patients with acute critical obstructive suppurative cholangitis who are intolerant of operation.

关 键 词：胆管炎 急危重症 皮经肝胆囊穿刺置管引流术 

分 类 号：R657.4[医药卫生—外科学]