经皮经肝胆囊穿刺术在术后早期炎性肠梗阻并发淤胆治疗中的应用

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 transhepatic 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1~4d,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 function and liver dysfunction. This paper is to determine the safety and effectiveness of percutaneous transhepatic cholecystostomy ( PTC ) in the treatment of cholestasis 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, gastrointestinal decompression, intestinal canal irrigation, TPN, somatostatin and low-dose glucocorticoid. All patients underwent ultrasound guided PTC. Results The study sample included 15 patients with clinical and sonographic or computerized tomographic signs of cholestasis. 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 ?.7 and 26. 6 ?0.5 days, respectively. The average duration following PTC drainage to evacuate was 2.3 ?.9 days ( range from 1 to 4 days ). Serum levels of glutamate-pymvate transaminase, glutamic 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 distended gallbladder or bile sludge could be found post-PTC. Conclusion Percutaneous transhepatic cholecystostomy may be a safe and effective treatment of cholestasis in postoperative inflammatory ileus patients.