超声引导经皮经肝胆囊穿刺置管引流术治疗危重老年急性胆囊炎疗效分析  

Clinical Effect of Ultrasound-guided Percutaneous Transhepatic Gallbladder Drainage in Treatment of Acute Cholecystitis in Critically ill Elderly Patients

作　　者：雷衍军[1] 肖彦[1] 潘小季[1] 王湘英[1] 卢武[1] 李玉姬 张璐璐 LEI Yan-jun;XIAO Yan;PAN Xiao-ji(Department of intensive Medicine,Hunan Provincial people＇s Hospital,Changsha,Hunan,410005)

机构地区：[1]湖南省人民医院重症医学一科,湖南长沙410005

出　　处：《医学临床研究》2018年第8期1480-1482,共3页Journal of Clinical Research

摘　　要：[目的]探讨超声引导经皮经肝胆囊穿刺引流术（PTGD）治疗危重老年急性胆囊炎的临床疗效.[方法]回顾性分析2012年1月至2018年1月于湖南省人民医院行PTGD治疗的56例危重老年急性胆囊炎患者的临床资料,记录患者穿刺并发症（出血、胆漏、肠穿孔、血气胸）;术前及术后d1、d3、d5患者体温、白细胞计数（WBC）、降钙素原（PCT）、谷丙转氨酶（ALT）、APACHEⅡ评分;术后3个月对患者随访,记录并统计患者术后情况及病死率.[结果]56例患者均一次穿刺成功,无并发症发生,d1患者体温较术前比较无显著差异（t=0.78,P=0.194）,术后d3、d5体温降至正常,与术前比较差异具有统计学意（P〈0.05）.患者WBC、PCT术后d5恢复正常,ALT于术后d3恢复正常,术后d1、d3、d5时WBC、PCT、ALT显著低于术前,差异具有统计学意义（P〈0.05）.术后d1、d3、d5患者APACHEⅡ评分逐步下降,显著低于术前,差异具有统计学意义（P〈0.05）.患者住院周期为5-17（9.2±3.8）d,穿刺引流后3个月内所有患者均无出血、胆漏、肠穿孔、血气胸等并发症.3例患者3个月随访时仍带管,随访时未复发胆囊炎,1例患者术后1个月意外拔管,择期行开腹胆囊切除术,1例患者术后1个月内因多器官功能衰竭病死.[结论]对危重老年急性胆囊炎患者早期、及时采取PTGD治疗,可有效缓解病情,降低围手术期风险,具有操作简单、患者术后并发症少、临床疗效较好的优点.[Objective]To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage （PTGD） in the treatment of acute cholecystitis in critically ill elderly patients. [Methods]The clinical data of 56 patients with acute cholecystitis treated with PTGD in Hunan Provincial people＇s Hospital from January 2012 to January 2018 were analyzed retrospectively. The puncture complications （bleeding, bile leakage, intestinal perforation, hemopneu- mothorax） were recorded. Body temperature, white blood cell count, （WBC）, procalcitonin （PCT）, alanine aminotrans-ferase （ALT） and Apache Ⅱ score were recorded before and 1 day ,3days , 5 days after operation, followed up 3 months after operation, and the postoperative condition and mortality were recorded and counted.[Results]All the 56 patients were successfully punctured at one time, and no complications occurred. There was no significant difference in body tem- perature between before and after operation （ t =0.78, P〈0.194）, but the body temperature decreased to normal on the 3rd ,5th day after operation （ P〈0.05）. On the 5th day after operation ,WBC and PCT returned to normal; on the 3rd day after operation, ALT returned to normal; WBC,PCT and ALT were significantly lower than those before operation on the 1st , 3rd and 5th day after operation （ P 〈0.05）. The scores of APACHE Ⅱ decreased gradually on the 5th day after operation, which were significantly lower than those before operation （ P 〈0.05）. The hospitalization period was 5- 17 （9.2 - 3.8） days. No bleeding, bile leakage, intestinal perforation and hemopneumothorax were found in all patients within 3 months after puncture and drainage. There was no recurrent cholecystitis in 3 cases at the time of 3- month fol- low-up even with the tube. One patient was accidentally extubated 1 month after surgery and underwent open cholecystec- tomy. One patient died of multiple organ failure within 1 month after operation.[Conclusion]In the early crit

关 键 词：胆囊炎 急性 穿刺术 超声检查 老年人 

分 类 号：R575.61[医药卫生—消化系统]