双通道植管联合胆道镜保胆取石治疗高龄结石性胆囊炎

目的：评价B超引导下胆囊穿刺双通道植管联合胆道镜保胆取石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12月收治的35例80岁以上急性结石性胆囊炎患者的临床资料。 结果：35例患者均行超声引导下胆囊穿刺双通道植管胆囊冲洗、减压、持续引流，6~8周后，行胆道镜经窦道保胆取石。所有患者超声引导穿刺植管均一次性成功，1例发生穿刺后出血，经对症处理止血成功；1例因植管窦道形成不佳改行胆囊切除术，余34例均成功保胆取石（34/35）；随访4~24个月，结石复发1例（1/34）。 结论：双通道胆囊穿刺植管联合胆道镜保胆取石治疗高龄高危胆囊结石方法简单、疗效可靠，具有推广价值。

Double-channel tube placement combined with choledochoscopic lithotomy for acute calculous cholecystitis in elderly patients

Objective: To evaluate the efficacy of gallbladder-preserving treatment via B-ultrasound-guided gallbladder puncture and dual-channel tube placement plus choledochoscopic lithotomy in treatment of acute calculous cholecystitis in high-risk elderly patients. Methods: The clinical data of 35 patients over 80 years of age with acute calculous cholecystitis admitted from January 2012 to December 2013 were retrospectively analyzed. Results: All the 35 patients underwent B-ultrasound-guided gallbladder puncture and dual-channel tube placement for lavage and decompression of the gallbladder and continued drainage, followed by choledochoscopic lithotomy via sinus tract with gallbladder preservation 6 to 8 weeks later. Ultrasound-guided gallbladder puncture and tube placement were successfully performed in all patients in one session, and bleeding occurred in one case after gallbladder puncture, which was controlled by hemostasis treatment. One case was converted to cholecystectomy due to incomplete sinus tract formation of the tube, and gallbladder-preserving cholecystolithotomy was successfully conducted in all the remaining 34 cases (34/35). Follow-up ranged for 4 to 24 months and stone recurrence was observed in one case (1/34). Conclusion: Dual-channel tube placement plus choledochoscopic gallbladder-preserving cholecystolithotomy for high-risk elderly patients with acute calculous cholecystitis is a simple treatment method with reliable efficacy, so its use is recommended.