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。

Percutaneous transhepatic gallbladder catheterizing drainge for acute cholecystitis in elderly patients

Objective To summarze the experience drawn from treatment of elderly patients with acutecholecystitis by percutaneous transhepatic gallbladder catheterizing drainage (PTGCD). Method Between January1992 and December 1996, eleven elderly patients who had undergone PTGCD were analysed retrospectively. Results The patients consisted of 5 women and 6 men, with a median age of 70 years (rage: 60-80 years). Allpatients presented with right upper abdominal pain, fever, and a palpable mass in the right upper quandrant.Sonographic examination showed gallbladder wall thickening and gallbladder distention in all patients, whereascholecystolithiasis was present in 9 cases. Rapid relief of clinical symptoms was observed 24 --48 hous after PTGCD in all patients. There were no complications related to catheterizational operation technique. Although catheters dislodged inadvertently 3 and 5 days after the procedure in two patients, no bile peritonitis occurredd. Fourcases underwent elective cholecystectomy 1-3 month after PTGCD. During follow-up, 3 cases died of non-biliarydiseases and the others remained free of biliary symptoms. Conclusion PTGCD is a simple, safe and effectiveprocedure for treatment of elderly patients with acute cholecystitis.