PTGD术后择期LC治疗老年急性重症胆囊炎应用体会

总结B超引流下经皮经肝胆囊穿刺引流(PTGD)联合腹腔镜胆囊切除术(LC)治疗老年急性重症胆囊炎的临床经验。回顾分析2008年1月—2013年10月接受PTGD治疗的140例老年急性重症胆囊炎患者的临床资料,其中124例择期在PTGD术后1~3个月行LC。140例患者肝穿刺置管成功,置管后1~3 h腹痛明显减轻,体温24~48 h降至正常,术后发生胆汁漏2例。16例非结石性胆囊炎患者愈后3~6周拔管;124例结石性胆囊炎患者术后1~3个月择期行LC,5例中转开腹。LC术后患者恢复顺利,无严重并发症。老年急性重症胆囊炎宜先行PTGD缓解炎症,以免发生胆囊穿孔,择期LC可明显改善预后。     

超声引导下经皮胆囊穿刺置管引流术治疗老年急性胆囊炎

目的总结超声引导下经皮胆囊穿刺置管引流术(PGCD)治疗老年急性胆囊炎的体会。方法对33例老年急性胆囊炎患者行超声引导下PGCD治疗,回顾性分析患者的临床资料。结果 33例患者中32例患者穿刺置管成功。经引流1~5 d,药物冲洗5~7 d后腹痛、发热、白细胞升高等临床症状及体征均明显缓解或消失。拔出引流管后均恢复良好,其中29例患者拔出引流管后择期行胆囊切除术,3例拒绝择期手术。1例穿刺中发生胆囊出血而终止穿刺,经药物止血治疗后急诊LC手术治愈。本组中无死亡病例,未发生引流管脱落、腹膜炎等意外或并发症。结论对老年急性胆囊炎患者在掌握适应证的基础上,实施超声引导下PGCD治疗创伤小、操作简便、安全性及有效率高。     

超声引导下双通道置管联合胆道镜保胆取石术治疗高龄急性结石性胆囊炎

目的 探讨超声引导下双通道置管联合胆道镜保胆取石术治疗高龄急性结石性胆囊炎患者的疗效.方法 回顾性分析2012年1月至2013年12月成都军区总医院收治的35例高龄(≥80岁)胆囊结石患者的临床资料,先在B超引导下行经皮胆囊双通道穿刺置管引流,后期联合胆道镜保胆取石术.术后长期口服消炎利胆药物,降低结石复发.采用电话和门诊随访,随访时间截至2014年6月30日.结果 35例患者B超引导下胆囊穿刺置管均一次性成功,1例发生穿刺后出血,经对症治疗止血成功;因置管窦道形成不佳改行胆囊切除术1例;余34例均成功取石;随访4～24个月,结石复发1例.结论 双通道胆囊穿刺置管联合胆道镜保胆取石治疗高龄急性结石性胆囊炎,该手术方式方法简单、疗效可靠,具有推广价值.     

B超引导下经皮经肝胆囊穿刺引流术治疗老年急性重症胆囊炎

目的：评价B超引导下经皮经肝胆囊穿刺引流术(PC)治疗老年急性重症胆囊炎的效果。方法：18例重症胆囊炎的老年患者接受了在局部麻醉下经皮经肝穿刺胆囊置管引流。结果：所有患者穿刺置管成功，无一例发生并发症，且症状及体征均于术后24～48h明显改善。结论：PC是一种微创、有效、廉价、可靠的治疗老年急性重症胆囊炎的方法。     

超声引导下经皮经胆囊穿刺置管引流术治疗80例急性胆囊炎

目的研究分析超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)对老年急性胆囊炎的诊断、治疗价值。方法选取2016年6月至2017年12月本院收治的急性胆囊炎患者80例作为研究对象,均行超声引导下经皮经肝胆囊穿刺置管引流术治疗。观察记录治疗前、治疗后病人临床症状是否改善;于治疗前、治疗后3天检查白细胞(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉酶(AMS)、脂肪酶(LPS)、总胆红素(TBil)、谷丙转氨酶(ALT)的指标水平;评估记录治疗后并发症相关情况。结果所有患者均在首次穿刺成功,引流胆汁通畅,引流量70~420ml/d,外引流管留置时间为10~53天,平均(17.49±5.22)天。老年患者的上腹部绞痛、胀痛等表现均在治疗后4~12小时快速缓解,治疗后1~3天体温恢复正常,胆囊炎典型体征消失。所有老年患者治疗后3天的WBC、PCT、CRP、AMS、LPS、TBiL、ALT指标水平明显低于治疗前(P0.05);80例老年患者治疗后3天的胆囊大小、胆囊壁压度明显小于治疗前(P0.05)。结论对老年急性胆囊炎患者行超声引导下经皮经肝胆囊穿刺置管引流治疗,临床症状可迅速改善,并对感染进行控制,防止因胆囊穿孔等导致的危重并发症的出现。另外此方法对老年患者创伤较小,安全性较高,适合临床医师选择应用。     

34例老年急性胆囊炎的手术治疗分析

回顾性分析34例老年急性胆囊炎患者的临床资料。其中急性结石性胆囊炎30例,非结石性急性胆囊炎4 例。行单纯胆囊切除28例,胆囊切除加胆道探查3例,胆囊部分切除2例,胆囊造瘘1例。术后并发肺部感染4例,双侧胸腔积液1例,切口感染3例。34例患者全部痊愈。老年急性胆囊炎确诊后若无手术禁忌证应及早手术治疗。     

超声引导经皮经肝胆囊穿刺置管引流术后择期腹腔镜胆囊切除术治疗高龄急性化脓性胆囊炎患者48例临床分析

目的探讨超声引导经皮经肝胆囊穿刺置管引流术(PTGD)治疗高龄急性化脓性胆囊炎患者的效果及安全性。方法选取2013-06—2016-06间汝州市人民医院收治的48例高龄急性化脓性胆囊炎患者,均首先在超声引导下行PTGD,待病情稳定后带管出院。2~3个月后择期行腹腔镜胆囊切除术。回顾性分析患者的临床资料。结果 48例患者均成功穿刺置管。均于引流5~7 d后病情稳定带管出院。其间未发生出血、胆汁外漏等并发症及引流管非计划拔脱。2~3个月后择期实施腹腔镜胆囊切除术治愈。结论对病情危重又不宜手术的高龄急性化脓性胆囊炎患者,采用超声引导下PTGD,方法简单易行、创伤小,可迅速缓解症状,阻止病情进展,安全性高。可为择期行腹腔镜胆囊切除术创造有利条件。     

微创技术联合治疗急性重症胆囊炎

目的:探讨微创技术联合治疗急性重症胆囊炎的临床疗效。方法:将180例急性重症胆囊炎患者分为治疗组(n=100)和对照组(n=80)。治疗组在B超引导下行经皮经肝胆囊穿刺置管引流(percutaneous transhepatic gallbladder catheteri-zing drainage,PTGCD)联合急诊腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),对照组行常规开腹胆囊切除术,对比分析两组患者手术时间、术中出血量、术后肠功能恢复时间及住院时间等。结果:治疗组手术时间、术中出血量、术后肠功能恢复时间、住院时间均优于对照组,差异有统计学意义(P<0.05);治疗组死亡例数及并发症发生率均少于对照组,差异有统计学意义(P<0.01)。结论:PTGCD联合LC治疗急性重症胆囊炎疗效确切,具有患者创伤小、痛苦小、康复快、并发症少等优点,值得推广应用。     

经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗老年急性梗阻性胆囊炎的体会

目的:探讨B超引导下经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)联合二期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗老年急性梗阻性胆囊炎的疗效。方法:回顾分析2008年1月至2011年2月为78例老年急性结石性胆囊炎患者行PTGD联合二期LC的临床资料。结果:78例均穿刺置管成功,术后2～3 h腹痛减轻,体温24～48 h降至正常,PTGD管平均留置13.5天,分别于6～48天后行LC。3例中转开腹,无一例因急性梗阻性胆囊炎及相关治疗导致的严重并发症或死亡。结论:PTGD联合二期LC是治疗老年急性梗阻性胆囊炎安全、简便、有效的方法。老年急性梗阻性胆囊炎应尽量避免急诊常规手术,宜先行PTGD,缓解炎症,以免发生胆囊穿孔,待二期择期行LC。     

PTGD治疗老年急性胆囊炎105例

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。     

Acute noncalculous cholecystitis following gastrectomy for gastric cancer--study by ultrasonic examination

In 190 patients who were operated for gastric cancer, incidence of post-operative noncalculous acute cholecystitis was studied. Twenty four patients was diagnosed as postoperative acute cholecystitis mainly by ultrasonic examination. As the sonographic appearance of 24 diagnosed cases, gallbladder distention was observed in 6 cases (25%), a thickened gallbladder wall in 19 cases (79%), intraluminal echoes within the gallbladder in 20 cases (83%) and sonolucent layer around the gallbladder in 14 cases (58%). In many cases clinical symptoms were so mild that without ultrasound they might be dealt with fever of unknown origin. With regard to treatment, conservative therapy by antibiotics was performed in 18 cases and ultrasonically guided percutaneous transhepatic gallbladder drainage in 6 cases. In many cases, sludge demonstrated during the initial stage of acute cholecystitis remained for long period. In 6 cases, intraluminal echoes gradually changed into gallstones. Frequency of postoperative acute cholecystitis was 12.6% (24/190)--Subtotal gastrectomy: 8.4% (11/131), total gastrectomy: 23.0% (11/48) and proximal gastrectomy: 18.2% (2/11). In cases of Appleby operation, incidence was especially high--27.0% (10/37). Acute cholecystitis after gastrectomy for gastric cancer is not so rate complication as considered previously.     

高龄急性胆囊炎的外科治疗

目的 探讨高龄急性胆囊炎患者治疗方法及手术时机。方法 回顾性分析73例高龄急性胆囊炎患者的临床特点和不同治疗方法对其预后影响。结果 死亡6例，均为急诊手术者，限期手术无死亡。结论 并存病是引起死亡的高危因素，对伴有并存病的高龄急性胆囊炎患者，应首先考虑经皮肝胆囊置管引流，等病情稳定，并存病改善后，限期手术，无并存病或伴有并发症者应及时手术。     

高龄病人超声引导下经皮经肝胆囊引流术的应用及临床价值

目的探讨高龄高危状态下超声引导经皮经肝胆囊引流术(percutaneous transhepatic gallbladder drainage，PTGD)的技术要点及治疗经验。方法超声引导下对13例高龄高危、合并其它重要器官疾病的急性胆囊炎患者施行PTGD术进行回顾性分析。结果除1例造瘘失败外，其余患者均成功置管、术后症状缓解、治愈出院，其中9例患者于12h内症状明显缓解。结论PTGD可迅速解除高龄高危患者急性胆囊炎引起的危急症状，避免因紧急手术引起的手术并发症，充分发挥了超声微创技术创伤少、方便灵活、准确安全的优势；明显降低死亡率、效果突出、值得推广。     

经皮经肝胆囊穿刺置管引流在老年急性胆囊炎病人中的应用

目的总结经皮经肝胆囊穿刺置管引流（ＰＴＧＣＤ）对老年急性胆囊炎的治疗经验。方法回顾性地分析１９９２年１月至１９９６年１２月期间接受ＰＩＧＣＤ治疗的１１例老年急性胆囊炎病人的临床资料。结果接受ＰＴＧＣＤ治疗的老年病人１１例,男６例,女５例,年龄６０－８０岁。Ｂ超检查显示所有病人胆囊壁增厚,胆囊增大,其中９例有胆囊结石。超声引导下ＰＴＧＣＤ后２４～４８小所有病人临床症状迅速缓解,未发生与穿刺操作有关的并发症。２例病人于置管后的第３和第５天导管移位脱出,但未发生胆汁性腹膜炎,因症状消失而出院。４例病人于ＰＴＧＣＤ后１—３个月行择期胆囊切除,３例院外死于与胆道无关疾病,其余病人保持无症状。结论ＰＴＧＣＤ可作为治疗老年急性胆囊炎的一项简便、安全、有效的方法。     

经皮经肝胆囊穿刺引流治疗高危急性胆囊炎 348 例临床分析

目的：分析超声引导下经皮经肝胆囊穿刺引流（UG-PTGD）治疗高危急性胆囊炎的效果。方法：对 348 例高危急性胆囊炎患者行 UG-PTGD 治疗，并对其临床资料进行回顾性分析。结果：348 例置管成功率 99.1%，术后 2 周内 97.7%患者症状消失。术后并发症出血 3 例，胆漏 1 例，穿刺部位疼痛 4 例，引流管堵塞或脱落 5 例，1 例因急性重型胰腺炎引发多脏器功能衰竭死亡，1 例术后 1 周心梗死亡。结论：UG-PTGD 是一种治疗高危急性胆囊炎的较好方法。     

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??Percutaneous transhepatic gallbladder drainage to treat acute pancreatitis complicated with acute cholecystitis guided by ultrasound: a report of 51 cases LI Gang??TONG Zhi-hui, ZOU Lei, et al. Medicine School of Nanjing University, Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing210002, China
Corresponding author: LI Wei-qin, E-mail??liweiqindr@yahoo.com
Abstract Objective To evaluate the safety and efficacy of percutaneous transhepatic gallbladder drainage (PTGD) guided by ultrasound in the treatment of acute pancreatitis complicated with acute cholecystitis. Methods The clinical data of 51 cases of acute pancreatitis complicated with acute cholecystitis performed PTGD from January 2009 to May 2012 in Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. Results All the cases were performed PTGD successfully without serious complications in the first try. In 72.5% of cases, the symptoms and signs were relieved after PTGD. The white blood cell count and the percentage of neutrophils were decreased obviously on the 1st day and 7th day after drainage. The incidence of high bilirubin (≥34.2μmol/L) and APACHE?? scores were declined significantly on the 3rd day after drainage. One case died of sepsis shock, and others were cured. In all cases, the catheters were removed in 1 month while no biliary obstruction was certified in gallbladder radiography. Conclusion PTGD is a simple, safe and effective treatment, which can make improvement of prognosis in acute pancreatitis complicated with acute cholecystitis.     

Ｂ超引导下经皮胆囊穿刺置管引流术治疗妊娠中晚期急性结石性胆囊炎

目的:探讨超声引导下经皮胆囊穿刺引流术(PPDG)治疗妊娠中晚期急性结石性胆囊炎的疗效。方法:回顾性分析2010年9月—2015年10月47例妊娠中晚期急性结石性胆囊炎患者行超声引导下PPDG的临床资料。结果:47例患者均成功实施PPDG,治疗后腹痛、发热等症状迅速缓解,无出血、胆瘘等并发症,实验室指标包括白细胞计数、转氨酶、总胆红素、降钙素原均较治疗前明显改善(均P0.05)。除1例患者置管后7 d导管脱落,其余患者均常规拔管或带管分娩后择期行胆囊切除术时拔管。47例患者28例自然分娩,19例剖宫产,新生儿均正常。结论:超声引导下PPDG是治疗妊娠中晚期急性结石胆囊炎有效、安全和简便的方法,推荐临床应用。     

Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly

BACKGROUND: The morbidity and mortality rates associated with acute cholecystitis are higher in the elderly. This study reports the results of treatment of acute cholecystitis in the elderly with emergency ultrasonographically guided percutaneous cholecystostomy followed by elective cholecystectomy after endoscopic treatment of any common bile duct stones diagnosed by percutaneous cholangiography. METHODS: From January 1989 to December 1998, 92 patients aged over 70 years were treated for acute gallstone cholecystitis. A group of 84 patients with ultrasonographic signs of severe cholecystitis or an American Society of Anesthesiologists score of II to IV were submitted to ultrasonographically guided percutaneous cholecystostomy. Transcatheter cholangiography was performed in all patients and endoscopic sphincterotomy was performed before operation in patients with common bile duct stones. After resolution of the acute phase and treatment of any associated diseases, patients were submitted to cholecystectomy. RESULTS: Cholecystostomy was performed successfully in 83 patients and permitted resolution of the acute attack in all after a mean period of 1.8 days. Cholangiography yielded a diagnosis of non-gallstone obstruction in one patient and common bile duct stones in 19 patients; preoperative endoscopic sphincterotomy and stone extraction was performed in 18 patients. Elective cholecystectomy was then performed in 70 patients with no deaths and a morbidity rate of 24 per cent. CONCLUSION: Combining emergency ultrasonographically guided percutaneous cholecystostomy, preoperative endoscopic treatment of common bile duct stones and subsequent elective cholecystectomy constitutes an optimal treatment regimen for acute gallstone cholecystitis in selected elderly patients with a mortality rate of zero in the authors' experience.     

介入超声联合胆道镜双通道“一步法”治疗高龄急性结石性胆囊炎的疗效观察

目的 探讨介入超声联合胆道镜双通道“一步法”治疗高龄高危急性结石性胆囊炎的临床可行性。方法 回顾性分析2016年6月至2018年7月于西部战区总医院就诊并接受该技术治疗的54例患者临床资料。结果 54例患者均成功完成双通道置管（超声引导下经皮经肝胆囊穿刺,同期行胆道镜取石）。其中50例患者取石成功,成功率为93%;并发症方面,1例出血,1例术后超声复查疑似胆漏。50例患者随访3～12个月,1例结石复发。结论 超声引导下经皮经肝胆囊穿刺同期胆道镜取石这种双通道“一步法”治疗高龄高危急性结石性胆囊炎安全有效,具有临床可行性。