经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗老年急性梗阻性胆囊炎的体会

目的:探讨B超引导下经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)联合二期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗老年急性梗阻性胆囊炎的疗效。方法:回顾分析2008年1月至2011年2月为78例老年急性结石性胆囊炎患者行PTGD联合二期LC的临床资料。结果:78例均穿刺置管成功,术后2～3 h腹痛减轻,体温24～48 h降至正常,PTGD管平均留置13.5天,分别于6～48天后行LC。3例中转开腹,无一例因急性梗阻性胆囊炎及相关治疗导致的严重并发症或死亡。结论:PTGD联合二期LC是治疗老年急性梗阻性胆囊炎安全、简便、有效的方法。老年急性梗阻性胆囊炎应尽量避免急诊常规手术,宜先行PTGD,缓解炎症,以免发生胆囊穿孔,待二期择期行LC。

Percutaneous transhepatic gallbladder drainage combined laparoscopic cholecystectomy in the treatment of acute and obstructive cholecystitis for aged patients

Objective:To investigate the practical value of ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD) combined with two-stage laparoscopic cholecystectomy(LC) in the treatment of acute obstructive cholecystitis in elder patients.Methods:Retrospective analysis was made on clinical data of 78 cases of PTGD and two-stage LC for elder patients with acute severe obstructive infection of gallbladder from Jan.2008 to Feb.2011.Results:PTGD+LC was performed successfully.All patients’ symptoms of abdominal pain were relieved after 2-3 h of operation,and temperature decreased to normal level 24-48 h after operation.The average time of draining was 13.5 days.All cases were performed LC 6-48 days after PTGD,and 3 patients received open cholecystectomy.No patient had severe complication or died after PTGD+LC.Conclusions:PTGD combined two-stage LC is simple and effective and safe treatment in high-risk acute obstructive infection of gallbladder.Aged patients with acute obstructive cholecystitis should avoid emergent routing operation,and receive PTGD first to relieve inflammation,in order to prevent perforation of gallbladder,selective LC should be applied later.