经皮经肝胆囊穿刺引流术治疗并发MODS的急性非结石性胆囊炎

目的探讨经皮经肝胆囊穿刺引流术(PTGBD)治疗并发多器官功能不全综合征(MODS)的急性非结石性胆囊炎(AAC)的手术时机与疗效。方法将2001年1月—2010年6月间收治的35例行PTGBD治疗的伴发MODS的AAC患者,依据发病至手术的时间长短分成早期手术组(4 d内手术,n=16)和晚期手术组(4 d后手术,n=19)。对两组的临床资料进行比较分析。结果 35例患者PTGBD均获成功,术后24 h内腹痛缓解,72 h内体温恢复正常;5 d内白细胞下降到正常。但两组之间差异无统计学意义(P>0.05)。早期手术组术后平均住院日(10.5±2.4)d,明显少于晚期手术组(17.1±3.2)d,(P<0.05)。早期手术组术后1周器官功能恢复率75.0%(12/16)明显高于晚期手术组47.4%(9/19),(P<0.05)。结论 PTGBD治疗伴发MODS的AAC具有良好的效果,治疗时机以发病4 d内为最佳,越早越好。

Study on percutaneous transhepatic gallbladder drainage for acute acalculous cholecystitis with MODS

Objective To explore the efficacy and timing of percutaneous transhepatic gallbladder drainage(PTGBD) for acute acalculous cholecystitis(AAC) with multiple organ dysfunction syndrome(MODS).Methods From January 2001 to June 2010,35 cases of AAC with MODS undergoing PTGBD were divided into two groups based on the length of time from onset of symptoms to surgical intervention: less than 4 days in the early PTGBD(E-PTGBD) group(n=16) and more than 4 days in the delayed 4 days PTGBD(D-PTGBD) group(n=19).The clinical data of two groups were analyzed contrastively.Results PTGBD succeeded in all patients.In the treatment of abdominal pain relief within 24 hours after,body temperature returned to normal within 72 hours,5 days down to normal white blood cells,there was no statistic difference between the two groups(P>0.05).E-PTGBD was average length of stay(10.5±2.4) days,significantly less than the D-PTGBD(17.1±3.2) days(P<0.05).Recovery rate of dysfunction organ was 75.0%(12/16) for E-PTGBD at one week after operation and 47.4 %(9/19) for D-PTGBD,the recovery rate in E-PTGBD group was significantly higher than in D-PTGBD group(P<0.05).Conclusion PTGBD has a good treatment effect for AAC with MODS.The best timing of treatment is within 4d after onset,the sooner the better.