PTGD治疗老年急性胆囊炎105例  

Treatment of Percutaneous Transhepatic Gallbladder Drainage for High-Risk Acute Cholecystitis in the Aged Patients

作　　者：牟泳霖 张筠[1] 曹军英[1] 里子彧[1] 于馨[1] 高越[1] 

机构地区：[1]沈阳军区总医院超声科,沈阳110011

出　　处：《中国现代手术学杂志》2017年第6期416-418,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨超声引导下经皮经肝胆囊穿刺置管引流术(percutaneous transhepatic gallbladder drainage,PTGD)治疗老年急性胆囊炎的临床价值。方法回顾分析我院2014年1月~2015年12月105例老年急性胆囊炎患者行PTGD的临床资料。本组患者年龄65~89岁,平均(70±10)岁;胆囊大于8 cm×4 cm。结果 104例(99.04%)一次性置管成功,1例置管失败患者行急诊手术。PTGD术后24 h白细胞数、总胆红素及丙氨酸氨基转移酶较术前明显降低(P<0.05),腹痛、发热及黄疸发生率亦较术前减少(P<0.05)。COOK引流管时间留置28~35 d,无脱管。术后74例择期行腹腔镜胆囊切除术,其中转为开腹手术1例,其余30例因年龄较大,合并症较多,未实施胆囊切除术,随访1年无胆囊原因死亡病例。结论合并多种内科疾病的老年急性胆囊炎患者急诊手术风险高,PTGD操作简便、安全,可以有效缓解临床症状,控制感染,特别适于不能耐受胆囊切除术的老年患者,并可治疗部分非结石性胆囊炎。Objective To evaluate the value of percutaneous transhepatic gallbladder drainage（PTGD） for aged acute cholecystitis patients. Methods The clinical data of 105 acute cholecystitis cases,aged from 65 to89,performed PTGD during January 2014 to December 2015 were analyzed retrospectively. The size of gallbladder was more than 8 cm × 4 cm in all cases. Results Of 105 cases,there were 104 cases（99. 05%） accomplished PTGD successfully. Emergency operation was performed in 1 patient failed intubation. There were no deaths in the whole group. Compared to preoperative level,the leukocyte count,total bilirubin and alanine aminotransferase enzyme were improved（P 0. 05）,and the incidence rate of abdominal pain,fever and jaundice 24 hours after the operation were reduced（P 0. 05）. The intubation time of COOK drainage tube was 28 to 35 days without cannula exodus. Selective laparoscopic cholecystectomy was carried out in 74 cases after PTGD,but one case conversed to open surgery. Conclusions For elderly patients with acute cholecystitis complicated with central pulmonary dysfunction and other diseases,emergency surgery has a high risk. PTGD can effectively relieve the clinical symptoms,control the infection and cure noncalculous cholecystitis,it is simple and safe for aged cases especially for cholecystemy-intolerance aged cases.

关 键 词：经皮经肝胆囊穿刺置管引流术 胆囊炎 急性 超声检查 老年人 

分 类 号：R657.41[医药卫生—外科学]