超声引导下经皮经肝胆囊穿刺置管引流治疗老年急性胆囊炎的价值

发布时间：2018-04-02 23:11

本文选题：超声引导　切入点：经皮经肝胆囊穿刺置管引流术　出处：《中国超声医学杂志》2017年10期

【摘要】：目的探讨超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)治疗老年急性胆囊炎的可行性及疗效。方法选取在我院行超声引导下PTGD手术的老年急性胆囊炎患者60例,所有患者均为合并一种或多种基础病的危重患者,收集其穿刺前后白细胞、降钙素原、C反应蛋白、淀粉酶、脂肪酶、谷丙转氨酶、总胆红素、胆囊大小及胆囊壁厚度等临床资料进行回顾性分析,并观察并发症的发生情况。结果 60例患者均一次性置管成功,对症处理2h后腹膜刺激症状消失,引流管保留时间9~54d,平均26d,与穿刺前相比所有患者的生化指标、胆囊大小、胆囊壁厚度均明显下降(P0.05)。60例患者中无严重出血、胃肠损伤、气胸及死亡病例,2例出现少量胆汁漏,3例堵管,1例引流管脱落。结论应用PTGD治疗老年性急性胆囊炎,可以快速缓解患者的临床症状,而且安全简单、疗效显著、痛苦小、并发症少,尤其适用于合并多种基础病不适宜手术治疗的危重老年患者,值得临床的应用与推广。
[Abstract]:Objective to investigate the feasibility and efficacy of percutaneous transhepatic cholecystectomy (PTGD) guided by ultrasound in the treatment of senile acute cholecystitis.Methods Sixty elderly patients with acute cholecystitis underwent PTGD operation under ultrasound guidance were selected. All the patients were critically ill with one or more basic diseases. The leukocytes, procalcitonin C reactive protein and amylase were collected before and after puncture.The clinical data of lipase, alanine aminotransferase, total bilirubin, gallbladder size and gallbladder wall thickness were analyzed retrospectively and complications were observed.Results all of the 60 patients were successfully placed tube at one time. The symptoms of peritoneal irritation disappeared after 2 hours of symptomatic treatment, and the retention time of drainage tube was 9 ~ 54 days (mean 26 days). Compared with before puncture, the biochemical indexes and the size of gallbladder in all patients were compared.The thickness of gallbladder wall was significantly decreased in 60 cases. There was no severe hemorrhage, gastrointestinal injury, pneumothorax and death in 2 cases, a small amount of bile leakage occurred in 3 cases.Conclusion the application of PTGD in the treatment of senile acute cholecystitis can relieve the clinical symptoms quickly, and is safe, simple, effective, less painful and less complicated.It is especially suitable for critically elderly patients who are not suitable for surgical treatment with many basic diseases. It is worthy of clinical application and popularization.
【作者单位】：河南科技大学临床医学院河南科技大学第一附属医院超声科;
【分类号】：R445.1;R657.41

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