CAJ | 학술논문

目的探讨经皮经肝胆囊穿刺引流术(PTGD)术后拔管指征.方法对2009年1月-2013年12月石河子大学医学院第一附属医院所收治的104例行PTGD的急性胆囊炎患者临床资料进行回顾性研究.结果全组104例患者均成功置管,腹痛明显缓解时间为0.5～8.0 h,平均(2.3±1.9)h,发热多数可于1d内缓解,置管时间为7～49 d,平均(22.4±10.3)d,其中13例于置管后3～12d意外脱管,5例再次行PTGD,8例给予抗感染、补液等对症治疗,均好转,再置管率为4.8％.78例患者于1～2个月后行腹腔镜胆囊切除术(LC),手术时间为35 ～ 95 min,平均(52.7±15.0) min,术中转开腹6例(7.7％),术中出血量30 ～ 150 mL,平均(61.7±31.0) mL.本组无围手术期死亡.结论行PTGD患者遵循拔管指征准确及时拔管,可有效减少患者带管期间引流管逆行感染、穿刺部位皮肤红肿渗出情况,缩短住院时间,并对后期行LC起到积极影响.
목적 탐토경피경간담낭천자인류술(PTGD)술후발관지정.방법 대2009년1월-2013년12월석하자대학의학원제일부속의원소수치적104례행PTGD적급성담낭염환자림상자료진행회고성연구.결과 전조104례환자균성공치관,복통명현완해시간위0.5～8.0 h,평균(2.3±1.9)h,발열다수가우1d내완해,치관시간위7～49 d,평균(22.4±10.3)d,기중13례우치관후3～12d의외탈관,5례재차행PTGD,8례급여항감염、보액등대증치료,균호전,재치관솔위4.8％.78례환자우1～2개월후행복강경담낭절제술(LC),수술시간위35 ～ 95 min,평균(52.7±15.0) min,술중전개복6례(7.7％),술중출혈량30 ～ 150 mL,평균(61.7±31.0) mL.본조무위수술기사망.결론 행PTGD환자준순발관지정준학급시발관,가유효감소환자대관기간인류관역행감염、천자부위피부홍종삼출정황,축단주원시간,병대후기행LC기도적겁영향.
Objective To study the indications for extubation of percutaneous transhepatic gallbladder drainage(PTGD).Methods Between January 2009 and December 2013,PTGD were performed on 104 patients with acute cholecystitis.The clinical data were analyzed retrospectively.Results PTGD were performed on all 104 patients successfully.In all the patients,after drainage the abdominal pain was relieved within 0.5 to 8 hours and mean time was(2.3 ± 1.9) h.The temperature decreased to normal in 1 days after drainage.The time of drainage was from 7 to 49 days,(22.4 ± 10.3) days on average.Thirteen patients'tubes were accidentally off during 3 to 12 days,5 patients were performed PTGD again,and 8 patients were given anti-infection,fluid infusion and other symptomatic treatments and all these patients were back to normal in time.Re-intubation rate was 4.8％.In 78 patients laparoscopic cholecystectomy (LC) were performed 1 to 2 months after PTGD.Operation time was between 35 to 95 min and mean time was(52.7 ± 15.0) min.There were 6 patients done open operation and the conservation rate was 7.7％.A mount of blood during LC was 30 to 150 mL,(61.7 ± 31.0) mL on average.No operative deaths occurred during therapeutic session.Conclusions Patients who formed PTGD obey the indications can extubate in time and reduce retrograde infection and skin irritation,also shorten the time during hospital's,which will have a positive impact about LC.