经皮肝胆囊穿刺置管引流术治疗创伤后中重度急性非结石性胆囊炎

目的 探讨经皮肝胆囊穿刺置管引流术（percutaneous transhepatic gallbladder drainage,PTGD）治疗创伤后中重度急性非结石性胆囊炎的临床疗效。方法 对2017年1月至2020年8月华北医疗健康集团邢台总医院普通外科收治的29例创伤（包括创伤和手术）后急性非结石性胆囊炎患者的临床资料进行回顾性分析。其中PTGD治疗21例（PTGD组）,腹腔镜下胆囊切除术治疗8例（LC组）。结果 PTGD组均一次性穿刺成功,患者治疗后血WBC、AST、GGT较治疗前降低,差异均有统计学意义（P<0.05）。安全渡过急性期后,3例（14.29%）于术后3个月行LC,恢复顺利;其余18例未行LC。LC组患者治疗后WBC、TBIL较治疗前降低,差异均有统计学意义（P<0.05）;3例中转开腹,其中2例为术前发生坏疽、穿孔,并且术后并发切口感染。术后随访6个月,两组患者油腻饮食后均无右上腹不适,无右上腹压痛、胆瘘等,PTGD组肝胆B超无胆囊壁毛糙、增厚等,LC组复查肝胆B超胆管明显无扩张等。结论 在无穿孔等并发症情况下,创伤后中重度急性非结石性胆囊炎及时行一针法经皮肝胆囊穿刺置管引流术安全性高且效果显著,部分患者能够痊愈,避免二次手术切除胆囊。

Clinical treatment of percutaneous transhepatic gallbladder drainage on moderate to severe acute acalculous cholecystitis after trauma

Objective To explore the clinical efficacy of percutaneous transhepatic gallbladder drainage on moderate to severe acute acalculous cholecystitis after trauma. Methods Clinical data of 29 patients with post-traumatic acute acalculous cholecystitis after trauma (including trauma and surgery) admitted to the General Surgery Department of Xingtai General Hospital of North China Medical & Health Group from Jan. 2017 to Aug. 2020 was retrospectivly analyzed. PTGD treated 21 cases (PTGD group), laparoscopic cholecystectomy LC (laparoscopic cholecystectomy) group treated 8 cases (LC group). Results All patients in the PTGD group were successfully punctured at one time. Blood WBC, AST and GGT of the patients after treatment were lower than those before treatment, the differences were statistically significant (P<0.05). Three months after PTGD, 3 cases underwent LC and recovered smoothly, the remaining 18 cases did not undergo LC. In LC group, postoperative blood WBC and TBIL in LC group were lower than those before treatment, and the difference was statistically significant (P<0.05). Three cases were converted to laparotomy, of which 2 cases suffered from preoperative gangrene and perforation and postoperative incision infection. During the 6-month follow-up after operation, Patient in the two groups had no right upper quadrant discomfort, no right upper quadrant tenderness and biliary fistula after a greasy diet. There were no gallbladder wall roughness and thickening was found in the reexamination of hepatobiliary B-ultrasound in PTGD group and no bile duct dilatation was evident in the reexamination of hepatobiliary B-ultrasound in LC group. Conclusion In the absence of complications such as perforation, timely one-needle percutaneous transhepatic gallbladder puncture and catheter drainage for post-traumatic moderate-to-severe acute acalculous cholecystitis is safe and effective, patients can be cured and avoid secondary operations.