PTGD序贯腹腔镜胆囊切除术在高危急性胆囊炎患者中的治疗作用

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摘要目的：回顾分析经皮肝胆囊穿刺引流术（PTGD）序贯腹腔镜胆囊切除术（LC)治疗高龄高危急性胆囊炎的效果。方法：选取温州医科大学附属第二医院育英儿童医院自2013年7月1日至2016年6月30日收治的高龄、高危急性胆囊炎患者54例，先行PTGD术，结合抗生素治疗，同时治疗合并疾病，PTGD后1周综合判断患者病情及患者家属手术的意愿选择PTGD术后1～2周（A组）或2～3个月（B组）序贯行LC治疗。结果：全部患者均成功行PTGD，成功率100%，治疗后腹痛发热等症状3 d内均缓解，无出血、胆漏等并发症，所有患者行LC过程均顺利，在手术时间、住院时间、术中失血、中转开腹、术后并发症方面差异均无统计学意义（P＞0.05），但延期行LC对患者生活增加不便。结论：高龄、高危急性胆囊炎患者可在急性期、手术条件较差的情况下先行PTGD迅速控制病情，再择期行LC。在部分基础疾病控制良好，且能够耐受手术的患者中早期行LC是安全可行的。

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	陈辉
	章旭明
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	郑鹏
	谢君青
	王继生
	周斌
	童洪飞

关键词 ：经皮经肝胆囊穿刺引流术, 高危, 急性胆囊炎, 腹腔镜胆囊切除术

Abstract：Objective: To summarize the experience in the treatment of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) sequential laparoscopic cholecystectomy (LC) in the elderly and high-risk patients with acute cholecystitis. Methods: The clinical data of 54 patients who underwent PTGD sequential LC between July 2013 and June 2016 were analyzed retrospectively. All the patients accepted LC after PTGD 1-2 weeks or 2-3 months determined by their family factors and physical status. Results: PTGD was successfully performed in all patients. Selective laparoscopic cholecystectomy was performed in 1-2 weeks or after 2-3 months. There was no significant difference between two groups in operative time, hospital stay, conversion to laparotomy and complications. Conclusion: PTGD is a safe, simple and effective procedure for treatment of elderly and high-risk patients with acute cholecystitis. If the patient’s conditions permit, early LC treatment was safe and feasible.

Key words： percutaneous transhepatic gallbladder drainage high-risk acute cholecystitis laparoscopic cholecystectomy

收稿日期: 2017-06-17

基金资助:浙江省中医药管理局青年基金资助项目（2014ZQ020）

通讯作者: 童洪飞，副主任医师，Email：tonghongfei@163.com。

作者简介: 陈辉（1983-），男，浙江温州人，主治医师，在职博士生。

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https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I3/185

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