PTGD治疗老年急性胆囊炎105例

doi:10.16260/j.cnki.1009-2188.2017.06.005

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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。

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	牟泳霖，张筠，曹军英，里子彧，于馨，高越

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

Abstract: ObjectiveTo evaluate the value of percutaneous transhepatic gallbladder drainage(PTGD)for aged acute cholecystitis patients.MethodsThe clinical data of 105 acute cholecystitis cases, aged from 65 to 89, 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.ResultsOf 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.ConclusionsFor 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.

Key words: percutaneous transhepatic gallbladder drainage cholecystitis, acute ultrasonography; aged

发布日期: 2018-05-28 期的出版日期: 2017-12-26

ZTFLH:

R657.41

通讯作者: 张筠

作者简介: 牟泳霖，女，30岁，沈阳军区总医院超声科住院医师。

引用本文:

牟泳霖，张筠，曹军英，里子彧，于馨，高越. PTGD治疗老年急性胆囊炎105例[J]. 中国现代手术学杂志, 2017, 21(6): 416-418.
MOU Yong-lin. Treatment of Percutaneous Transhepatic Gallbladder Drainage for High-Risk Acute Cholecystitis in the Aged Patients. Chinese Journal of Modern Operative Surgery, 2017, 21(6): 416-418.

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http://www.surgerychina.com/CN/10.16260/j.cnki.1009-2188.2017.06.005 或 http://www.surgerychina.com/CN/Y2017/V21/I6/416

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