序贯式双通道胆囊穿刺造瘘联合胆道镜微创保胆取石

目的:探讨超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石术治疗高龄高危急性结石性胆囊炎患者的疗效.方法:回顾性分析2012年1月-2013年4月接受双通道胆囊穿刺造瘘联合胆道镜保胆取石术治疗的30例高龄高危急性结石性胆囊炎患者的临床资料.结果:30例患者均穿刺置管成功,1例发生出血,向腔内注入立止血,夹闭弓引流管后出血停止,带管时间为14d至2个月,平均时间为30 d.4～8周后,28例患者成功行胆道镜取石,1例患者因窦道未形成行开腹胆囊切除术,1例患者因16F猪尾型外导管滑脱行腹腔镜胆囊切除术.28例患者获随访3～19个月,B超检查1例(3.6％)复发.结论:超声引导双通道胆囊穿刺造瘘联合胆道镜保胆取石是治疗高龄高危胆囊结石患者可靠、有效的方法.

Sequential procedures of percutaneous double-tract cholecystostomy and choledochoscopic minimally invasive cholecystolithotomy with gallbladder preservation

Objective: To investigate the efficacy of ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy for high-risk elderly patients with acute calculous cholecystitis. Methods: The clinical data of 30 patients with acute calculous cholecystitis, who underwent percutaneous cholecystostomy and choledochoscopic cholecystolithotomy from January 2012 to April 2013, were retrospectively analyzed. Results: Gallbladder punctures and tube placement were successfully performed in all the 30 patients. Bleeding occurred in one patient during the procedure, which was controlled by intraluminal injection of reptilase and catheter occlusion. The tube retention time was 14 d to 2 months with average of 30 d. After 4- to 8-week drainage, gallbladder stones in 28 patients were successfully removed via choledochoscope, one patient underwent open cholecystectomy because of failure of sinus tract formation, and another patient received laparoscopic cholecystectomy due to loose connection of the 16-F cholecystostomy pigtail tube. Twenty-eight patients were followed up for 3 to 19 months, and recurrence was found in one patient (3.6%) by B ultrasonic examination. Conclusion: Ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy is a reliable and effective approach for high-risk elderly gallstone patients.