摘要
目的禁食、全胃肠外营养(total parenteral nutrition,TPN)时间长及应用生长抑素治疗,引起少数术后早期炎性肠梗阻(early postoperative inflammatory ileus,EPII)患者出现淤胆症状。文中探讨经皮经肝胆囊穿刺术(percutaneous transhe-patic cholecystostomy,PTC)在术后EPII并发淤胆患者中的应用价值。方法回顾性分析15例腹部手术后EPII并发淤胆患者运用PTC的治疗效果。患者均行B超或腹部CT检查,常规进行禁食、胃肠减压、灌肠、TPN、生长抑素、小剂量糖皮质激素等综合治疗,运用PTC行胆汁外引流。结果 15例患者均非手术治愈,无穿刺并发症发生,平均住院时间为(32.5±5.7)d,TPN支持时间平均为(26.6±10.5)d,穿刺后至肛门排气为1～4 d,平均时间为(2.3±0.9)d。11例患者谷丙转氨酶(GPT)、谷草转氨酶(GOT)、γ-谷氨酰转肽酶(γ-GT)、碱性磷酸酶(AKP)、总胆红素、直接胆红素水平升高,穿刺后GPT、GOT、γ-GT、AKP、总胆红素、直接胆红素水平较快恢复正常,淤胆症状消失。6例患者出现低热、右上腹不适症状,穿刺后体温恢复正常,右上腹不适症状缓解。结论 PTC运用安全有效,虽不能根本改变术后EPII的病理过程,但能明显改善术后患者因禁食而长期应用TPN导致的淤胆症状,改善肝功能,恢复胆汁流,促进肠蠕动,加速康复。
Objective One of the most important issues in a patient with suspected early postoperative inflammatory ileus is the risk of cholestasis resulting from fasting, total parenteral nutrition （TPN） and somatostatin, which can lead to stasis of biliary func- tion and liver dysfunction. This paper is to determine the safety and effectiveness of pereutaneous transhepatic choleeystostomy （PTC） in the treatment of eholestasis in early postoperative inflammatory ileus patients. Methods A retrospective study was made on the treatment of PTC on 15 early postoperative inflammatory ileus patients with cholestasis. Routine treatment included fasting, gastrointes- tinal decompression, intestinal canal irrigation, TPN, somatostatin and low-dose glucocortieoid. All patients underwent uhrasound guided PTC. Results The study sample included 15 patients with clinical and sonographic or computerized tomographie signs of cho- lestasis. The 15 patients comprised nine men and six women （age 47.6 ±18.3years; range 13 -78 years）. There was no procedure complication with PTC. The average time of hospital stay and total TPN was 32.5 ± 5.7 and 26.6 ± 10.5 days, respectively. The aver- age duration following lYl＇C drainage to evacuate was 2.3 ± 0.9 days （ range from 1 to 4 days ）. Serum levels of glutamate-pyruvate transaminase, glutamie oxalacetic transaminase, gamma-glutamyl transpeptidase, alkaline phosphotase, total bilirubin and direct biliru- bin were mildly high pro-PTC in 11 patients, and became normal very soon post-PTC. There were 6 patients who had low-grade fever and right upper quadrant discomfort pro-PTC. All patients showed rapid recovery of clinical symptoms following PTC drainage. No dis- tended gallbladder or bile sludge could be found post-PTC. Conclusion Pereutaneous transhepatie cholecystostomy may be a safe and effective treatment of eholestasis in postoperative inflammatory ileus patients.
出处
《医学研究生学报》
CAS
北大核心
2012年第5期503-505,共3页
Journal of Medical Postgraduates
关键词
经皮经肝胆囊穿刺术
早期炎性肠梗阻
胆汁瘀积
全胃肠外营养
Percutaneous transhepatie cholecystostomy
Early postoperative inflammatory ileus
Cholestasis
Total parenteral nutrition
