超声引导下经皮经肝胆囊穿刺引流术在急性胆囊炎老年高危患者中的应用

目的通过分组对比的方式，观察经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage，PTGD)的治疗效果，及其对择期手术的影响，分析并评价PTGD在急性胆囊炎老年高危患者中的应用价值。 方法回顾性分析扬州大学附属医院普外科2016年3月至2018年3月收治的急性胆囊炎患者189例，选取符合本次试验病例纳入标准的患者78例。其中根据急性期治疗方式不同，将其分为2组，一组接受PTGD治疗，另外一组接受常规抗感染等保守治疗。每组随机选取30例，分别为试验组和对照组。分别对比2组患者首次入院时，从接受治疗开始，腹痛持续时间，体温恢复正常所用时间，抗生素的使用时间。入院治疗48～72 h抽血检测的血液中白细胞计数、转氨酶、总胆红素指标。并对择期腹腔镜胆囊切除术的手术时间，术中出血量，2次治疗总费用，术后并发症发生率进行比较。 结果试验组患者腹痛持续时间(21.10±3.99)h明显低于对照组患者(32.50±6.52)h，试验组患者体温恢复至正常(36.5≤T≤37.2 ℃)所用时间(13.37±3.78)h较对照组患者(28.70±9.27)h明显缩短。入院后48h白细胞计数试验组(8.34±1.80)×10⁹/L低于对照组(11.78±2.09)×10⁹/L，试验组谷丙转氨酶(87.50±30.72)U/L、谷草转氨酶指标(90.57±30.84)U/L低于对照组(110.33±25.81、119.93±29.67)U/L，总胆红素指标试验组(15.24±4.43)mmol/L低于对照组(19.45±5.17)mmol/L。试验组患者抗生素使用时间(3.82±0.83)d少于对照组患者(6.88±1.24)d。差异均具有统计学意义(P<0.05)。患者出院1～3个月至我院行腹腔镜胆囊切除术，试验组手术时间(58.17±10.92)min、术中出血量(25.67±6.02)ml与对照组(58.00±11.73)min、(24.67±5.62)ml相比，差异无统计学意义。治疗总费方面无明显差异。 结论对急性胆囊炎老年高危患者，采取PTGD治疗可以迅速降低胆囊内压力，控制炎症发展，有效地缓解腹痛、发热等感染所带来的临床症状，降低胆囊穿孔和感染性休克等严重并发症发生的风险，加快转氨酶下降速度，保护肝功能，为择期手术创造一定的条件。

Application of percutaneous transhepatic gallbladder drainage in aged and high-risk patients with acute cholecystitis

ObjectiveTo observe the therapeutic effect of percutaneous transhepatic gallbladder drainage(PTGD)and its effect on elective surgery by grouping comparison, and to analyze the application value of PTGD among aged and high-risk patients with acute cholecystitis. MethodsA total of 189 patients with acute cholecystitis were analyzed retrospectively in Affiliated Hospital of Yangzhou University from March 2016 to March 2018.And 78 patients who were eligible for the screening criteria were selected.According to different treatments in acute term, these patients were divided into two groups.One group accepted PTGD treatment, and the other one accepted anti-infection conventional treatment.Thirty patients were randomly selected respectively in each group as the experimental group and the control group.The time of abdominal pain duration, the time of backing to normal body temperature and the time for antibiotic usage of the two groups were compared after the patients were admitted to the hospital first time for treatment.The number of white blood cell, transaminase and total bilirubin between 48 h and 72 h after admission were compared.In addition, the operation time of elective laparoscopic cholecystectomy, peroperative bleeding, total expense of the two operations and complication rate were compared. ResultsAbdominal pain duration of patients in the experimental group [(21.10±3.99)h]was obviously shorter than that in the control group [(32.50±6.52)h]. Time for temperature recovery(36.5 ℃≤T≤37.2 ℃)in the experimental group [(13.37±3.78)h]was apparently shorter than that in the control group [(28.70±9.27)h]. White blood cell number in the experimental group [(8.34±1.80)×10⁹/L]48 hours after admitted was lower than that in the control group [(11.78±2.09)×10⁹/L]. Alanine transaminase and glutamic oxaloacetic transaminase in the experimental group [(87.50±30.72)U/L, (90.57±30.84)U/L]were lower than those in the control group [(110.33±25.81)U/L, (119.93±29.67)U/L]. Total bilirubin in the experimental group [(15.24±4.43)mmol/L]was lower than that in the control group [(19.45±5.17)mmol/L]. The time for antibiotic usage in the experimental group [(3.82±0.83)d]was shorter than that in the control group [(6.88±1.24)d]. All the differences of these results were statistically significant(P<0.05). All the patients were treated by laparoscopic cholecystectomy after 1-3 months in our hospital.There were no obvious differences between the two groups in terms of operation time [(58.17±10.92)min vs.(58.00±11.73)min]and amount of bleeding [(25.67±6.02)ml vs.(24.67±5.62)ml]. And there was no obvious difference in terms of expense. ConclusionFor those high-risk elderly patients, PTGD can reduce the pressure in the gallbladder, control the development of inflammation, relieve symptoms of infection abdominal pain and fever quickly and effectively.PTGD can reduce the risk of serious complications such as gallbladder perforation and septic shock.PTGD also can accelerate the decrease of transaminase, protect liver function and create certain conditions for elective surgery.