摘要
目的探讨经皮胆囊穿刺引流术在高危急性胆囊炎患者中的治疗策略及临床疗效。方法回顾2006年1月-2008年6月27例高危急性胆囊炎患者进行的经皮胆囊穿刺引流术,其中21例为结石性胆囊炎,6例为非结石性胆囊炎;22例行经皮经肝穿刺引流,5例经腹腔胆囊穿刺引流。引流管直径为7F;引流管拔除前给予胆囊造影。结果27例患者成功完成手术,技术成功率100%。25例患者术后引流通畅,72h内腹痛症状减轻或消失,体温及白细胞降至正常范围。1例术后72h腹痛缓解不明显,行胆囊造影显示引流管不通,给予通畅引流管后腹痛症状缓解。1例术后出现腹痛加重,行胆囊造影复查显示少量胆汁外漏,给予加强抗感染治疗及对症治疗后好转。25例于术后6～7周拔管,其中12例接受了择期胆囊切除术,7例行经窦道结石取出术,6例非结石性胆囊炎患者未予手术治疗。2例患者长期带管生存。结论对于高危急性胆囊炎患者,经皮胆囊穿刺引流术操作简单、安全,疗效确切,具有重要临床应用价值。
Objective To discuss the therapeutic strategy and the clinical efficacy of percutaneous cholecystostomy in treating high-risk patients with acute cholecystitis. Methods During the period of Jan. 2006-June 2008, percutaneous eholecystostomy was performed in 27 high-risk patients with acute cholecystitis, consisting of lithic cholecystitis （n = 21） and non-lithic cholecystitis （n = 6）. Of 27 patients, percutaneous cholecystostomy via transhepatic approach was performed in 22 and via transperitoneal approach in 5. The 7 F drainage catheter was used. Cholecystography was conducted before the drainage catheter was extracted. Results Percutaneous cholecystostomy was successfully accomplished in all 27 cases, with a technical success rate of 100%. Postoperative patency of gallbladder drainage was obtained in 25 patients, with the relieving or subsiding of abdominal pain and the restoring of temperature and leukocyte account to normal range within 72 hours. In one patient, as the abdominal pain relief was not obvious 72 hours after the procedure, cholecystography was employed and it revealed the obstruction of the drainage catheter. After reopening of the drainage catheter, the abdominal pain was relieved. In another case, cholecystography was carried out because the abdominal pain became worse after the procedure, and minor bile leak was demonstrated. After powerful anti-infective and symptomatic medication, the abdominal pain was alleviated. The drainage catheter was extracted in 25 patients 6 - 7 weeks after the treatment. Of these 25 patients, 12 accepted selective cholecystectomy, 7 received percutaneous cholecystolithotomy and 6 with non-lithic cholecystitis did not get any additional surgery. The remaining two patients were living with long-term retention of the indwelling drainage-catheter. Conclusion Percutaneous cholecystostomy is a simple, safe and effective treatment for acute cholecystitis in high-risk patients. This technique is of great value in clinical practice.
出处
《介入放射学杂志》
CSCD
北大核心
2009年第6期449-452,共4页
Journal of Interventional Radiology
关键词
急性胆囊炎
高危
经皮胆囊穿刺引流
胆囊造影
percutaneous cholecystostomy
acute cholecystitis
high risk
cholecystography
