本文選題：超聲引導(dǎo)　切入點：經(jīng)皮經(jīng)肝膽囊穿刺置管引流術(shù)　出處：《中國超聲醫(yī)學(xué)雜志》2017年10期

【摘要】：目的探討超聲引導(dǎo)下經(jīng)皮經(jīng)肝膽囊穿刺置管引流術(shù)(PTGD)治療老年急性膽囊炎的可行性及療效。方法選取在我院行超聲引導(dǎo)下PTGD手術(shù)的老年急性膽囊炎患者60例,所有患者均為合并一種或多種基礎(chǔ)病的危重患者,收集其穿刺前后白細(xì)胞、降鈣素原、C反應(yīng)蛋白、淀粉酶、脂肪酶、谷丙轉(zhuǎn)氨酶、總膽紅素、膽囊大小及膽囊壁厚度等臨床資料進行回顧性分析,并觀察并發(fā)癥的發(fā)生情況。結(jié)果 60例患者均一次性置管成功,對癥處理2h后腹膜刺激癥狀消失,引流管保留時間9~54d,平均26d,與穿刺前相比所有患者的生化指標(biāo)、膽囊大小、膽囊壁厚度均明顯下降(P0.05)。60例患者中無嚴(yán)重出血、胃腸損傷、氣胸及死亡病例,2例出現(xiàn)少量膽汁漏,3例堵管,1例引流管脫落。結(jié)論應(yīng)用PTGD治療老年性急性膽囊炎,可以快速緩解患者的臨床癥狀,而且安全簡單、療效顯著、痛苦小、并發(fā)癥少,尤其適用于合并多種基礎(chǔ)病不適宜手術(shù)治療的危重老年患者,值得臨床的應(yīng)用與推廣。
[Abstract]:Objective to investigate the feasibility and efficacy of percutaneous transhepatic cholecystectomy (PTGD) guided by ultrasound in the treatment of senile acute cholecystitis.Methods Sixty elderly patients with acute cholecystitis underwent PTGD operation under ultrasound guidance were selected. All the patients were critically ill with one or more basic diseases. The leukocytes, procalcitonin C reactive protein and amylase were collected before and after puncture.The clinical data of lipase, alanine aminotransferase, total bilirubin, gallbladder size and gallbladder wall thickness were analyzed retrospectively and complications were observed.Results all of the 60 patients were successfully placed tube at one time. The symptoms of peritoneal irritation disappeared after 2 hours of symptomatic treatment, and the retention time of drainage tube was 9 ~ 54 days (mean 26 days). Compared with before puncture, the biochemical indexes and the size of gallbladder in all patients were compared.The thickness of gallbladder wall was significantly decreased in 60 cases. There was no severe hemorrhage, gastrointestinal injury, pneumothorax and death in 2 cases, a small amount of bile leakage occurred in 3 cases.Conclusion the application of PTGD in the treatment of senile acute cholecystitis can relieve the clinical symptoms quickly, and is safe, simple, effective, less painful and less complicated.It is especially suitable for critically elderly patients who are not suitable for surgical treatment with many basic diseases. It is worthy of clinical application and popularization.
【作者單位】： 河南科技大學(xué)臨床醫(yī)學(xué)院河南科技大學(xué)第一附屬醫(yī)院超聲科;
【分類號】：R445.1;R657.41

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