经皮经肝胆囊穿刺置管药物冲洗引流治疗老年急性化脓性胆囊炎

目的 总结经皮经肝囊穿刺置管药物冲洗引流治疗老年急性化脓性胆囊炎的治疗经验。方法 采用F8PTRO套管针穿刺，经肝经路；经腹腔经路。结果 对186例病人采用本方法治疗均获得穿刺成功，无出血、胆汁漏胆汁性腹膜炎等合并症。药物冲洗1周，胆囊炎症即完全控制。本组有4例2d内脱管给予重新置管，12例3d后脱管，因胆囊炎症基本控制未再置管，7例合并黄疸的病人胆囊炎症控制后黄疸亦随之消退，7例做了择期胆囊切除、胆总管切开取石，3例因合并有胆总管结石出现中毒性休克，自动出院，1例死于心衰。结论 经皮经肝胆囊穿刺置管药物冲洗引流是治疗老年急性化脓性胆囊炎的一种安全、微创、有效方法。

Treatment of acute suppurative cholecystitis by percutaneous transhepatic and transchlecystic placement of catheter for drug douche and drainage in aged patients

Objective To summarize the experience in treatment of acute suppurative cholecystitis by percutaneous transhepatic and transchlecystic placement of catheter for drug douche and drainage in aged patients. Methods F8PTRO trochar was used to perform the puncture through the transabdominal and transhepatic route. Results The puncture was successfully made in all the patients and there were no bleeding, biliary fistula and biliary peritonitis. In most of the patients, symptoms were completely controlled after one week douche and drainage. The catheter dropped in 4 cases within 2 days after placement and was placed again. In another 12 patients with catheter dropping within 3 days after the placement, the catheter was not placed again because the symptoms were basically controlled. In 7 patients with complication of jaundice, the complication gradually disappeared after the treatment. Another 7 cases eventually received selective cholecystectomy or choledocholithotomy. Three patients with the complication of choledocholith developed toxic shock and voluntarily left the hospital. One patient died of heart failure. Conclusions Percutaneous transhepatic and transcholecystic placement of catheter for drug douche and drainage can effectively reduce death rate. Therefore, it is a safe, effective and slightly traumatic method for treatment of acute suppurative cholecystitis in aged patients.