CT引导下经皮胆囊造瘘术治疗高龄、危重急性胆囊炎患者

目的 评估CT引导下经皮胆囊造瘘术治疗高龄、危重急性胆囊炎患者的临床价值并对并发症等问题进行探讨。方法 对16例不能进行急诊胆囊切除手术的高龄、危重急性胆囊炎患者行CT引导下经皮经肝穿刺胆囊造瘘术，在胆囊内置放直径为7～8．5F猪尾引流管引流潴留胆汁，观察胆囊造瘘前后患者临床症状、体征及血白细胞计数的变化情况。结果 16例患者CT引导下经皮胆囊造瘘均获得成功。15例术后12～48h临床症状、体征缓解；1例术后无缓解。5例非结石性胆囊炎术后21～28d拔管后康复；10例结石性胆囊炎30～60d行胆囊切除手术。无严重并发症。结论 CT引导下经皮胆囊造瘘术是1种操作简便、安全有效的胆囊造瘘方法，对于治疗高龄、危重的急性胆囊炎患者具有较为重要的临床价值。     

经皮经肝胆囊穿刺置管引流术治疗急性化脓性胆囊炎21例

【摘要】 目的 评价在DSA 设备引导下经皮经肝胆囊穿刺置管引流术治疗急性化脓性胆囊炎的疗效及应用价值。方法 回顾性分析南京医科大学附属南京江宁医院2015年4月至2018年12月通过经皮经肝胆囊穿刺置管引流术治疗的21例急性化脓性胆囊炎患者的临床资料。观察并记录患者治疗前后临床症状及相关实验室检查和治疗结果。结果 所有患者均一次性置管成功,经皮经肝胆囊穿刺置管引流术治疗前后的白细胞计数［（10.81±7.11）×109对（7.27±3.54）×109］、体温［（38.3±0.6）℃对（37.3± 0.3）℃］及疼痛评分［（6.00 ±1.30）对（4.79±0.89）］差异均有统计学意义（P均＜0.05）。其中19例患者在3 d内腹痛症状缓解,腹部体征减轻或消失;6例患者好转后行二期外科手术。置管后1例患者出现感染加重,1例患者出现感染性休克,1例患者拔管后出现胆汁漏。结论 对于急性化脓性胆囊炎采用经皮经肝胆囊穿刺置管引流术是一种安全有效的治疗方案。操作简单、并发症少,能明显缓解症状,可为二期外科手术提供条件,值得临床推广应用。     

高危急性胆囊炎采用经皮经肝胆囊穿刺引流术治疗的临床分析

目的 探究高危急性胆囊炎采用经皮经肝胆囊穿刺引流术治疗的临床效果.方法 选取收治的64例高危急性胆囊炎患者,随机分为两组,对照组(32例)患者采用开腹胆囊摘除术治疗,实验组(32例)患者采用经皮经肝胆囊穿刺引流术治疗,对两组患者治疗效果对比分析.结果 实验组患者手术时间与术中出血量均明显优于对照组,差异显著(P＜0.05),具有统计学意义.实验组患者术后并发症发生率为15.6％(5/32),对照组患者术后并发症发生率为28.1％(9/32),对比差异显著,P＜0.05,具有统计学意义.结论 在高危急性胆囊炎患者中,采用经皮经肝胆囊穿刺引流术治疗,其具有创伤小、康复快、并发症少、手术时间短等优势,能够显著改善患者的症状.     

急性重症胆囊炎的介入治疗

目的评价利用经皮胆囊造口术治疗急性重症胆囊炎的临床疗效。方法97例急性重症胆囊炎患者接受超声及DSA结合导引下的经皮胆囊造口术,并于术中置管引流。结果所有97例患者均一次置管成功,无任何并发症。93例(96%)患者临床体征如右上腹疼痛、发热在72h内缓解;同时,血常规中的WBC及中性粒细胞均于72h内降至正常范围。4例患者由于肝总管内结石合并胆管炎临床症状缓解不明显而于第2天行经皮肝穿胆管引流术,术后临床症状于72h内亦缓解。结论经皮经肝胆囊穿刺置管引流术是治疗急性重症胆囊炎安全有效的方法。     

X线下经皮胆囊穿刺引流治疗急性重症胆囊炎31例分析

目的 评价X线下经皮经肝胆囊穿刺引流术治疗急性重症梗阻性胆囊炎患者的临床疗效和治疗经验.方法 对2006年1月-2008年12月31例急性重症梗阻性胆囊炎患者行X线引导下的经皮经肝胆囊穿刺引流术治疗,通过对比术前、术后实验检查及临床症状的改善评价疗效.结果 31例患者均成功置入引流管,未发生相关并发症.1例合并急性肾功能衰竭患者死亡,其余30例患者症状缓解并带管出院.16例结石性胆囊炎患者于术后1～3个月行择期胆囊切除术,8例结石性胆囊炎患者选择带管生存,6例非结石性胆囊炎患者于胆囊炎治愈后3周至6周拔管.结论 X线下经皮胆囊穿刺引流术操作简便、创伤小、安全性高,是急性重症胆囊炎患者的一种过渡治疗,甚至是终末治疗方法.     

胆囊穿刺置管引流治疗老年化脓性胆囊炎的护理

目的:探讨经皮经肝胆囊穿刺置管引流(PTGBD)治疗老年急性化脓性胆囊炎的护理方法。方法:采用B超监视下定位PTCD套管针经皮经肝穿刺胆囊,留置8.5F外引流管持续引流冲洗。结果:18例患者均一次穿剌置管成功,首次引流脓液50~120ml。引流后患者全身症状和体征迅速好转,7~10天后症状基本消失,白细胞计数恢复正常。置管维持7~15天,住院16~31天,平均18.9天,18例患者均痊愈,无出血、胆汁性腹膜炎等并发症。结论:经皮经肝胆囊穿刺置管引流术对不能耐受手术的老年急性化脓性胆囊炎患者是一种安全、微创和有效的方法,全面严密细致的术前准备及术后护理,有助于提高手术的疗效和减少并发症。     

B超定位胆囊穿刺造瘘术治疗高龄急性胆囊炎78例报告

目的：探讨B超定位胆囊穿刺造瘘术对高龄急性胆囊炎患者的疗效。方法：分析2003—08～2006—08我科以B超定位胆囊穿刺造瘘术治疗的78例高龄（≥70岁）急性胆囊炎患者的临床资料，78例入院前合并各种疾病者72例（92．3％）。结果：78例全部成功施行穿刺造瘘（100％），无出血、胆瘘等并发症发生，74例治愈出院（94．9％），4例（5．1％）死亡，出院51例（65．4％）3个月后行腹腔镜胆囊切除，术后患者恢复好。结论：B超定位胆囊穿刺造瘘可迅速缓解高龄患者急性胆囊炎引起的危急症状，避免急诊开腹手术带来的风险，具有微创、方便、安全等优势，可明显降低死亡率，值得推广。     

63例急性胆囊炎B超引导下经皮经肝胆囊穿刺置管引流护理体会

急性胆囊炎是肝胆外科常见的急版症之一，胆囊颈部结石梗阻或嵌顿足其发病的主要诱因。本文回顾我科2001年3月至2004年3月期间，63例急性胆囊炎，胆囊积液患者，施行B超引导下经皮经肝胆囊穿刺减压，置管引流术，治疗取得满意效果。在治疗过程中护理至关重要。     

经皮胆囊穿刺引流术在高危急性胆囊炎患者中的应用

目的 探讨经皮胆囊穿刺引流术在高危急性胆囊炎患者中的治疗策略及临床疗效.方法 回顾2006年1月-2008年6月27例高危急性胆囊炎患者进行的经皮胆囊穿刺引流术,其中21例为结石性胆囊炎,6例为非结石性胆囊炎;22例行经皮经肝穿刺引流,5例经腹腔胆囊穿刺引流.引流管直径为7 F;引流管拔除前给予胆囊造影.结果 27例患者成功完成手术,技术成功率100%.25例患者术后引流通畅,72 h内腹痛症状减轻或消失,体温及白细胞降至正常范围.1例术后72 h腹痛缓解不明显,行胆囊造影显示引流管不通,给予通畅引流管后腹痛症状缓解.1例术后出现腹痛加重,行胆囊造影复查显示少量胆汁外漏,给予加强抗感染治疗及对症治疗后好转.25例于术后6～7周拔管,其中12例接受了择期胆囊切除术,7例行经窦道结石取出术,6例非结石性胆囊炎患者未予手术治疗.2例患者长期带管生存.结论 对于高危急性胆囊炎患者,经皮胆囊穿刺引流术操作简单、安全,疗效确切,具有重要临床应用价值.     

高龄患者急性重症胆囊炎的处理（附52例报道）

目的回顾研究高龄患者急性重症胆囊炎的治疗效果。方法 52例急性重症胆囊炎的高龄患者分别进行急诊手术（10例）、B超引导下经皮经肝穿刺胆囊置管引流＋手术切除（39例）及B超引导下经皮经肝穿刺胆囊置管引流（3例）,研究其治疗效果和并发症。结果 49例手术治疗患者无手术死亡;42例经PTGD治疗患者无出血、气胸、胆漏、胆汁性腹膜炎等并发症发生,治疗后1～3 d症状明显缓解。结论对于全身情况稳定,胆囊壁厚度≤0.5 cm的患者宜行急诊手术治疗;对胆囊壁厚度〉0.5 cm,全身情况差或有严重内科疾病的患者宜先采用B超引导下经皮经肝穿刺胆囊置管引流,再行手术治疗的方案。     

Percutaneous cholecystolithotomy: preliminary experience and technical considerations

Surgical cholecystectomy is associated with a high morbidity and mortality in elderly patients with acute calculous cholecystitis and underlying cardiac or pulmonary disease. Currently there are few alternatives for treating these patients. The authors have used percutaneous cholecystolithotomy in 11 such high-risk patients for definitive treatment of gallbladder calculi. In all 11 patients all stones were successfully removed from the gallbladder and cystic duct. The entire procedure--from initial tube placement to final tube removal--lasted 17-40 days (mean, 21 days). There were two complications: one minor--local wound infection--and one major--bile peritonitis with eventual death. Percutaneous cholecystolithotomy is an effective alternative therapy for acute calculous cholecystitis in elderly, debilitated patients.     

急性非结石性胆囊炎的诊断治疗分析

目的总结急性非结石性胆囊炎的诊断和治疗经验。方法对我院1999年3月—2010年11月收治的19例急性非结石性胆囊炎患者的临床资料进行回顾性分析。结果 19例患者均行手术治疗,其中胆囊切除12例,胆囊大部切除2例,胆囊造瘘3例,胆总管探查、T管引流2例。术前误诊7例,误诊率36.8%。除2例死于术后多脏器功能衰竭外,其余病例均治愈出院。结论急性非结石性胆囊炎病情急、进展快、临床表现不典型。早期诊断和及时手术治疗是提高其治愈率和降低死亡率的关键。     

超声引导下经皮经肝胆囊穿刺治疗化脓性胆囊炎的价值

目的:探讨在超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎的价值。方法:对30例急性化脓性胆囊炎在超声引导下经皮经肝胆囊穿刺抽脓、甲硝唑反复冲洗,最后注入并保留敏感抗生素,1次/2 d,连续1~3次。另对30例经皮经肝胆囊穿刺置管引流(PTGCD)急性化脓性胆囊炎作为对照组(只用甲硝唑冲洗)。结果:两组各30例均穿刺成功。治疗后两组腹痛24 h内明显减轻、体温48 h内降至正常、血白细胞一周降至正常范围、3~4周B超复查胆囊正常、单纯胆囊壁增厚、胆囊萎缩、胆囊收缩功能正常及并发症的例数分别为:治疗组28,29,30,19,10,1,26,0例;对照组23,22,23,10,18,3,20,8例,其中并发症8例中局部皮肤感染2例,引流管脱落4例,引流管堵塞1例,胆漏1例。两组病程分别为治疗组8.4±2.25 d,对照组15.6±5.82 d。经统计学处理,除腹痛24 h内明显减轻及3~4周B超复查胆囊萎缩两项指标外均有显著性差异。结论:超声引导下经皮经肝胆囊穿刺甲硝唑冲洗、敏感抗生素注入并保留治疗化脓性胆囊炎是一种简单、安全、有效的方法。     

Acute cholecystitis: ultrasonographic staging and percutaneous cholecystostomy.

Experience in the treatment of acute cholecystitis with percutaneous cholecystostomy in 29 high-risk and elderly patients is reported. The treatment group included 14 men and 15 women, 21 of whom were over 70 years of age. The suspected clinical diagnosis of acute cholecystitis was confirmed in all cases by ultrasonography (accuracy: 95.6%). The percutaneous cholecystostomy was successful in 27 of 29 cases and these patients had a sudden improvement in their clinical condition; failure of the procedure was due in one patient to dislodgement of the catheter and in another patient to the guide-wire slipping out of the gallbladder. Six patients complained of pain radiating to the right shoulder which disappeared within 30-60 minutes after the procedure. Twenty-three of the 27 patients subsequently underwent elective cholecystectomy. In 22 patients the ultrasonographic findings were compared with the histology; thus enabling us to establish an ultrasonographic staging of acute cholecystitis related to the seriousness of the disease. Percutaneous cholecystostomy is the treatment of choice in high-risk patients, in the elderly, as well as in young patients with impending perforation.     

Technical report: percutaneous cholecystostomy in acute acalculous cholecystitis.

Acute acalculous cholecystitis is a significant cause of morbidity and mortality in patients with other serious illnesses (Howard, 1981) and the mortality rate after surgical cholecystostomy may reach 15% (McGahan and Lindfors, 1989). Radiologically controlled percutaneous cholecystostomy is a safe, minimally invasive, procedure which may be curative (McGahan and Lindfors, 1989; Berger et al., 1989). Both cases described here were successfully treated by percutaneous cholecystostomy. A modified Seldinger technique was used in one and a direct 'trocar' puncture in the other. Percutaneous cholecystostomy, which is technically relatively straightforward, is now the treatment of choice for acute acalculous cholecystitis.     

The Chait Trapdoor cecostomy catheter: an alternative access device to pigtail catheters for chronic cholecystostomy drains

Acute cholecystitis is a well known complication in the critically ill patient population. These patients are often at high risk for morbidity and mortality associated with cholecystectomy. Percutaneous cholecystostomy has been shown to be an effective procedure in the treatment of acute cholecystitis in this patient population. Some patients require prolonged catheter drainage before definitive therapy. In four patients with patent cystic ducts, standard drainage catheters were exchanged for 10.2-F Chait pediatric cecostomy catheters. The low profile of the catheter and the "Trapdoor" feature allow maintenance and increased patient satisfaction while maintaining drainage and access.     

PTGD联合LC治疗高龄高危急性结石性胆囊炎32例

目的 总结经皮肝胆囊穿刺引流(PTGD)联合腹腔镜胆囊切除术(LC)对高龄高危急性结石性胆囊炎患者的治疗经验.方法 回顾分析我中心2008年5月～2010年5月采用PTGD联合LC序贯治疗32例高龄高危结石性胆囊炎患者的临床资料.结果 32例均穿刺置管,全部获得有效引流,1 w～3个月后行LC,中转开腹4例;无出血及漏...     

Percutaneous cholecystostomy in non-surgical patients

PURPOSE: To assess the efficacy and complications of percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in non-surgical patients. MATERIALS AND METHODS: Retrospective study of 25 cases (16 males and 9 females) of PC. The average age was 82 years (range: 59-95). Eight had acute acalculous cholecystitis (AAC) and 17 had acute calculous cholecystitis (ACC). US-guided percutaneous cholecystostomy was performed in most cases; CT-guidance was required in 5 cases. RESULTS: One technical failure and one complication (abdominal wall hematoma) occurred. PC was successful for sepsis control in 21 patients (5 AAC and 16 ACC): delayed cholecystectomy was performed in one patient, and one patient had recurrent acute cholecystitis at one month that responded to medical management. For the 4 remaining patients: 1 corresponded to the technical failure, and failure of sepsis control was observed in the 3 others patients (2 AAC, 1 ACC). PC was the definitive treatment or resulted in sepsis control in 84% of cases. PC was the definitive treatment, without recurrence, in 76% of cases. CONCLUSION: US or CT guided percutaneous cholecystostomy is an effective treatment, with a low rate of complication, in elderly or critically ill patients. PC can be used as a definitive treatment or as a temporizing measure in critically ill patients allowing for delayed definitive surgical/endoscopic management.