中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
6期
2493-2496
,共4页
胆囊炎,急性%经皮经肝胆囊穿刺引流术%超声检查%手术后并发症
膽囊炎,急性%經皮經肝膽囊穿刺引流術%超聲檢查%手術後併髮癥
담낭염,급성%경피경간담낭천자인류술%초성검사%수술후병발증
Cholecystitis,acute%Percutaneous transhepatic gallbladder drainage%Ultrasonography%Postoperative complications
目的观察利用超声引导下经皮经肝胆囊穿刺引流（ PTGBD）治疗危重急性胆囊炎的临床疗效。方法回顾性分析2008年8月至2012年2月收治的88例急性胆囊炎患者的临床资料，其中PTGBD治疗44例（穿刺组），急诊行胆囊切除术治疗44例（手术组），分别比较两组患者的ASA分级及合并症，两组间术后并发症及术后90 d内死亡率。结果穿刺组患者在ASA分级、2种以上合并症方面要比手术组患者严重，差异具有统计学意义（ P＜0.05）。手术组：手术成功43例，1例腹腔镜胆囊切除术中转开腹。术后并发胆漏1例，不完全性肠梗阻1例，胆囊床渗血及肝周积液2例，切口脂肪液化坏死延迟愈合4例，下肢深静脉血栓形成1例，肺感染2例。穿刺组：44例均穿刺置管成功，术后24～72 h内腹痛缓解，体温降至正常，并发2例胆汁渗漏，1例引流管脱出；死亡4例。两组并发症发生率（6.8％ vs．25％）具有统计学差异（P＜0．05）。结论在高龄、危重急性胆囊炎患者中，急症胆囊切除和PTGBD是有效的治疗措施。 PTGBD能迅速缓解症状，可减少并发症发生率。病情稳定后，腹腔镜胆囊切除术是有效的治疗手段。
目的觀察利用超聲引導下經皮經肝膽囊穿刺引流（ PTGBD）治療危重急性膽囊炎的臨床療效。方法迴顧性分析2008年8月至2012年2月收治的88例急性膽囊炎患者的臨床資料，其中PTGBD治療44例（穿刺組），急診行膽囊切除術治療44例（手術組），分彆比較兩組患者的ASA分級及閤併癥，兩組間術後併髮癥及術後90 d內死亡率。結果穿刺組患者在ASA分級、2種以上閤併癥方麵要比手術組患者嚴重，差異具有統計學意義（ P＜0.05）。手術組：手術成功43例，1例腹腔鏡膽囊切除術中轉開腹。術後併髮膽漏1例，不完全性腸梗阻1例，膽囊床滲血及肝週積液2例，切口脂肪液化壞死延遲愈閤4例，下肢深靜脈血栓形成1例，肺感染2例。穿刺組：44例均穿刺置管成功，術後24～72 h內腹痛緩解，體溫降至正常，併髮2例膽汁滲漏，1例引流管脫齣；死亡4例。兩組併髮癥髮生率（6.8％ vs．25％）具有統計學差異（P＜0．05）。結論在高齡、危重急性膽囊炎患者中，急癥膽囊切除和PTGBD是有效的治療措施。 PTGBD能迅速緩解癥狀，可減少併髮癥髮生率。病情穩定後，腹腔鏡膽囊切除術是有效的治療手段。
목적관찰이용초성인도하경피경간담낭천자인류（ PTGBD）치료위중급성담낭염적림상료효。방법회고성분석2008년8월지2012년2월수치적88례급성담낭염환자적림상자료，기중PTGBD치료44례（천자조），급진행담낭절제술치료44례（수술조），분별비교량조환자적ASA분급급합병증，량조간술후병발증급술후90 d내사망솔。결과천자조환자재ASA분급、2충이상합병증방면요비수술조환자엄중，차이구유통계학의의（ P＜0.05）。수술조：수술성공43례，1례복강경담낭절제술중전개복。술후병발담루1례，불완전성장경조1례，담낭상삼혈급간주적액2례，절구지방액화배사연지유합4례，하지심정맥혈전형성1례，폐감염2례。천자조：44례균천자치관성공，술후24～72 h내복통완해，체온강지정상，병발2례담즙삼루，1례인류관탈출；사망4례。량조병발증발생솔（6.8％ vs．25％）구유통계학차이（P＜0．05）。결론재고령、위중급성담낭염환자중，급증담낭절제화PTGBD시유효적치료조시。 PTGBD능신속완해증상，가감소병발증발생솔。병정은정후，복강경담낭절제술시유효적치료수단。
Objective To observe the clinical improvement of ultrasound guided percutaneous transhepatic gallbladder drainage ( PTGBD) in treating critically ill patients with acute cholecystitis .Methods The clinical data of 88 patients of high-risk acute cholecystitis patients admitted between August 2008 and February 2012 were analyzed retrospectively .The puncture group included 44 cases treated with PTGBD and the operation group included 44 cases undergoing emergency cholecystectomy .ASA classification, complication, postoperative complications and mortality within 90 days of their operation were compared between the two groups .Results The puncture group patients were more serious than the operation group in ASA classification and complication , there were statistically significant differences in two groups ( P<0.05 ) .The complications of the operation group after operation included:two cases with biliary leak , three with cholangitis , one with effusion around liver , one cases with incomplete intestinal obstruction and 2 patients bleeding from the gallbladder bed .Four patients with delayed healing because of the wound fat liquefaction necrosis .Lower extremity deep vein thrombosis in 1 case and one with pulmonary infection with the 4 died cases,the puncture group was successfully performed in 44 cases.The abdominal pains relived after 24-72 hours and the temperature returned to normal .The complications included:one case with biliary leak , the dislodgement of drainage tube occured in 1 patient,which compared with the complications of the operation group were statistically significant(P<0.05).Conclusions PTGBD and emergency cholocystectomy are highly efficient in resolving acute cholecystitis in high-risk patients.PTGBD under ultrasonographic guidance is a simple ,easy to perform and reliable procedure ,reduce the incidence of the complications and high success rates for critically ill patients with acute cholecystitis .Elective laparoscope cholecystectomy is the treatment of choice for patients after the condition of acute cholecystitis stable .
