超声引导下经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的临床观察

摘要/Abstract

摘要： 目的：探讨超声引导下经皮经肝胆囊穿刺置管引流术（ultrasound-guided percutaneous transhepafic gallbladder drainage， UG-PTGD）在老年急性胆囊炎（acute cholecystitis）治疗中的临床疗效。方法：回顾性分析我院2017年1月至2020年6月确诊的23例老年急性胆囊炎并经UG-PTGD患者的临床资料，患者年龄62～94岁，中位年龄75.4岁；急性胆囊炎分级均为Ⅲ级，ASA分级均为Ⅲ级以上。结果：23例患者均一次穿刺置管成功，术后引流通畅。术前1 d与术后3 d各项指标对比如下：体温(38.4±0.5) ℃降至(36.7±0.3) ℃；白细胞计数(11.62±5.58)×109·L-1降至(8.72±3.42)×109·L-1；总胆红素(118.96±21.27) μmmol·L-1降至(74.37±20.11) μmmol·L-1；谷丙转氨酶(157.15±39.56) U·L-1降至(101.39±28.43) U·L-1；疼痛评分(7.7±1.4)分降至(4.9±1.0)分；均P＜0.05。所有患者均无出血、胆漏、消化道损伤、血气胸、腹腔脓肿等并发症发生。23例急性胆囊炎患者均带管出院。7例患者择期行胆囊切除术；12例患者术后带管生存；1例非结石性胆囊炎患者UG-PTGD后3～5周临床症状好转，闭管1周后无不适并行超声、胆囊造影等检查明确胆囊及胆管通畅无扩张后拔管；3例患者因其他疾病死亡；所有患者均未发生胆囊炎复发或引流相关因素死亡。结论：UG-PTGD是老年急性胆囊炎患者简单安全有效的治疗措施。

关键词: font-size:medium, ">超声引导下的胆囊穿刺置管引流术；急性胆囊炎；老年

Abstract: Objective： To investigate the clinical effect of ultrasound-guided percutaneous transhepafic gallbladder drainage (UG-PTGD) in the treatment of elderly patients with acute cholecystitis. Methods： The clinical data of 23 elderly acute cholecystitis cases， who underwent UG-PTGD treatment during January 2017 to June 2020 in our hospital were analyzed retrospectively.The median age of the patients was 75.4 years old (range 62～94 years old). The patients were all grade Ⅲ acute cholecystitis，and their ASA classification were all above level Ⅲ. Results： All the 23 patients underwent UG-PTGD succeeded at the first puncture， and the postoperative drainage was unobstructed .The relevant indexes of the patients 1 d before UG-PTGD and 3 d after UG-PTGD were compared： the temperature reduced from (38.4±0.5)℃ to (36.7±0.3)℃，white blood cell count reduced from (11.62±5.58)×109·L-1 to (8.72±3.42)×109·L-1，total bilirubin reduced from (118.96±21.27) μmmol·L-1 to (74.37±20.11) μmmol·L-1， alanine aminotransferase reduced from (157.15±39.56) U·L-1 to (101.39±28.43) U·L-1 and the visual analog scale（VAS） score of abdominal pain reduced from (7.7±1.4) to (4.9±1.0)，（P＜0.05）. No complication occurred after UG-PTGD in all the patients， such as hemorrhage， bile leakage， gastrointestinal injury， hemopneumothorax and abdominal abscess. All the 23 patients were discharged with drainage tube in body. 7 cases underwent cholecystectomy at an appropriate time. 12 cases lived with drainage tube in the body. The clinical symptoms of 1 case with non-calculous cholecystitis improved 3-5 weeks after UG-PTGD， and there was no discomfort 1 week after tube closure，so after ultrasound and cholecystography examinations confirming that the gallbladder and bile duct were unobstructed without dilation， the drainage tube was removed. 3 cases died of other diseases. No cholecystitis recurrence or drainage-related death occurred in all the 23 patients. Conclusion： UG-PTGD is a simple， safe and effective treatment method for elderly patients with acute cholecystitis.

Key words: font-size:medium, ">Ultrasound-guided percutaneous transhepafic gallbladder drainage； Acute cholecystitis； Elderly

中图分类号:

邱凯, 郭艳芳, 王林军, 于海明. 超声引导下经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的临床观察[J]. 中国医药导刊, 2021, 23(6): 407-410.

QIU Kai, GUO Yanfang, WANG Linjun, YU Haiming. Clinical Observation on the Treatment of Elderly Patients with Acute Cholecystitis by Ultrasound-guided Percutaneous Transhepafic Gallbladder Drainage[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(6): 407-410.

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