超声引导下经皮经肝胆囊穿刺引流术治疗急性胆囊炎的临床效果

摘要

Objective To investigate the clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of acute cholecystitis.Methods A retrospective analysis was performed for the clinical data of 81 patients with acute cholecystitis who underwent ultrasound-guided PTGBD in General Hospital of Lanzhou Petrochemical Company from March 2013 to February 2016.The changes in related parameters after the placement of drainage tube were analyzed.The t-test was used for comparison of continuous data between groups.Results All the 81 patients underwent a successful one-time puncture.After the surgery,1 patient experienced tube dislodgement and 2 experienced obstructed bile drainage,while no patient experienced serious complications such as bleeding,bile leakage,and hemopneumothorax.Within 12 hours after surgery,there was a significant improvement in pain in the right upper quadrant and significant reductions in the major axis and radial width of the gallbladder (t =13.28 and 9.54,P =0.023 and 0.041),as well as significant reductions in white blood cell count and neutrophil count (t =8.70 and 8.03,P =0.028 and 0.034).Of all patients,38 achieved symptom remission after the placement of drainage tube and refused selective surgical treatment,and 43 underwent cholecystectomy within 3 months after surgery.Conclusion PTGBD is simple,convenient,visible,and safe and can effectively reduce patients' pain,increase the success rate of the treatment of acute cholecystitis,improve patients' clinical outcomes,and reduce the incidence of complications.It also provides the conditions of selective surgery for critically ill patients with acute cholecystitis,and therefore,it holds promise for clinical application.%目的 探讨超声引导下经皮经肝胆囊穿刺引流术(PTGBD)对急性胆囊炎的治疗效果.方法 回顾性分析兰州石化总医院2013年3月-2016年2月行超声引导下PTGBD的81例急性胆囊炎患者临床资料,比较置管前后检测指标变化.计量资料组间比较采用t检验.结果 81例患者均一次穿刺成功,术后有1例患者发生脱管,2例胆汁引流不畅,但均未发生出血、胆漏、血气胸等严重并发症.术后12 h内,患者右上腹疼痛症状明显好转,术后患者胆囊长径、胆囊宽径均较术前明显减小(t值分别为13.28、9.54,P值分别为0.023、0.041),WBC和中性粒细胞均较术前明显降低(t值分别为8.70、8.03,P值分别为0.028、0.034).其中,38例患者置管后症状缓解,拒绝择期手术治疗,余43例患者于术后3个月内行胆囊切除手术.结论 PTGDB具有简便性、可视性、安全性等优点,可有效减少患者痛苦,提高急性胆囊炎治疗的成功率和疗效,降低并发症的发生,为危重急性胆囊炎患者提供择期手术的条件,值得临床推广应用.