PTGD序贯腹腔镜胆囊切除术在高危急性胆囊炎患者中的治疗作用  

The treatment of percutaneous transhepatic gallbladder drainage for acute cholecystitis in high-risk patients

作　　者：陈辉[1] 章旭明[1] 洪重 郑鹏 谢君青 王继生[1] 周斌[1] 童洪飞[1] CHEN Hui;ZHANG Xuming;HONG Zhong;ZHENG Peng;XIE Junqing;WANG Jisheng;ZHOU Bin;TONG Hongfei(Department of Hepatopancreatobiliary Surgery,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou,325027)

机构地区：[1]温州医科大学附属第二医院育英儿童医院肝胆胰外科,浙江温州325027

出　　处：《温州医科大学学报》2018年第3期185-188,193,共5页Journal of Wenzhou Medical University

基　　金：浙江省中医药管理局青年基金资助项目(2014ZQ020)

摘　　要：目的:回顾分析经皮肝胆囊穿刺引流术(PTGD)序贯腹腔镜胆囊切除术(LC)治疗高龄高危急性胆囊炎的效果。方法:选取温州医科大学附属第二医院育英儿童医院自2013年7月1日至2016年6月30日收治的高龄、高危急性胆囊炎患者54例,先行PTGD术,结合抗生素治疗,同时治疗合并疾病,PTGD后1周综合判断患者病情及患者家属手术的意愿选择PTGD术后1~2周(A组)或2~3个月(B组)序贯行LC治疗。结果:全部患者均成功行PTGD,成功率100%,治疗后腹痛发热等症状3d内均缓解,无出血、胆漏等并发症,所有患者行LC过程均顺利,在手术时间、住院时间、术中失血、中转开腹、术后并发症方面差异均无统计学意义(P>0.05),但延期行LC对患者生活增加不便。结论:高龄、高危急性胆囊炎患者可在急性期、手术条件较差的情况下先行PTGD迅速控制病情,再择期行LC。在部分基础疾病控制良好,且能够耐受手术的患者中早期行LC是安全可行的。Objective:To summarize the experience in the treatment of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD)sequential laparoscopic cholecystectomy(LC)in the elderly and highrisk patients with acute cholecystitis.Methods:The clinical data of 54 patients who underwent PTGD sequential LC between July 2013 and June 2016 were analyzed retrospectively.All the patients accepted LC after PTGD 1-2 weeks or 2-3 months determined by their family factors and physical status.Results:PTGD was successfully performed in all patients.Selective laparoscopic cholecystectomy was performed in 1-2 weeks or after 2-3 months.There was no significant difference between two groups in operative time,hospital stay,conversion to laparotomy and complications.Conclusion:PTGD is a safe,simple and effective procedure for treatment of elderly and high-risk patients with acute cholecystitis.If the patient’s conditions permit,early LC treatment was safe and feasible.

关 键 词：经皮经肝胆囊穿刺引流术 高危 急性胆囊炎 腹腔镜胆囊切除术 

分 类 号：R605.97[医药卫生—急诊医学]