Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 于浩 , 刘武 , 姜洪磊 , 金俊哲 ,  梁健

中国医科大学附属第四医院肝胆外科（辽宁沈阳 110032）;

Corresponding author：

梁健, Email: liangj63110@vip.sina.Com

Keywords：

经皮经肝胆囊穿刺; 腹腔镜胆囊切除术; 急性重症胆囊炎

DOI：

10.7507/1007-9424.20140228

Video：

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目的探讨超声引导下经皮经肝胆囊穿刺引流术（PTGD）联合二期腹腔镜胆囊切除术（LC）治疗急性胆囊炎的安全性和可行性。方法回顾性分析我院2008年7月至2013年7月期间对急性胆囊炎先行PTGD后二期LC的117例患者的临床资料。结果本组117患者PTGD术后均成功实施二期LC，PTGD术顺利，无并发症发生，PTGD管平均留置时间27.4 d（21～31 d）。LC采用单孔法33例，三孔法84例，全部病例均治愈。手术平均时间为48.5 min（32～92 min），腹腔引流管拔除平均时间为2.3 d（2～4 d）。无中转开腹者，无胆管损伤、出血、胆汁漏等并发症发生。病理结果为急性胆囊炎。本组随访患者无术后并发症。结论超声引导下PTGD联合二期LC治疗急性胆囊炎安全、有效。

Citation： 于浩, 刘武, 姜洪磊, 金俊哲, 梁健. Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 951-953. doi: 10.7507/1007-9424.20140228 Copy

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2.	赵庆峰, 白文坤.超声引导下经皮经肝胆囊穿刺引流治疗急性梗阻性胆囊炎20例分析[J].齐鲁医学杂志, 2012, 27(6): 538-539.
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4.	Spanos C P, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review[J]. Langenbecks Arch Surg, 2006, 391(5): 441-447.
5.	邹宏雷, 张都民, 杜鹃.腹腔镜胆囊切除术中的复杂情况及处理对策[J].中国普外基础与临床杂志, 2012, 19(2): 204-207.
6.	Spira RM, Nissan A, Zamir O, et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis[J]. Am J Surg, 2002, 183(1): 62-66.
7.	杜冬, 崔忠, 孙建斌, 等.经皮经肝胆囊穿刺置管引流治疗老年重症急性胆囊炎[J].临床误诊误治, 2012, 25(2): 78-79.
8.	王宏, 罗建管, 梁鹏, 等.腹腔镜胆囊切除术胆管损伤危险因素分析[J].中国实用外科杂志, 2011, 31(7): 591-593.
9.	文君, 肖渝清, 张抒, 等.急诊腹腔镜胆囊切除与急诊开腹胆囊切除术的临床对照研究[J].中国普外基础与临床杂志, 2013, 20(2): 195-198.
10.	Huang CC, Lo HC, Tzeng YM, et al. Percutaneous transhepatic gallbladder drainage: a better initial therapeutic choice for patients with gallbladder perforation in the emergency department[J]. Emerg Med J, 2007, 24(12): 836-840.
11.	李正起, 陈灵丽. PTGD治疗急性胆囊炎的临床疗效观察[J].海南医学院学报, 2012, 18(1): 71-73.
12.	赵龙, 钱建军, 柏斗胜.经脐单孔腹腔镜胆囊切除术的学习曲线研究[J].中国现代普通外科进展, 2013, 16(4): 282-289.
13.	林叶, 金浩生, 简志祥.经脐单孔腹腔镜与传统腹腔镜治疗胆囊良性疾病的对比研究[J].南方医科大学学报, 2013, 33(8): 1199-1202.
14.	陈伟荣, 李佩球, 章庆华.经脐单孔腹腔镜胆囊切除术临床应用体会[J].中国内镜杂志, 2013, 18(8): 875-876.
15.	袁德汉, 陈应军, 卫洪波.腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析[J].中国内镜杂志, 2013, 19(5): 492-495.
16.	谷化剑, 冯贤松, 辛小燕.医源性胆道损伤的原因分析与防治策略[J].中国普通外科杂志, 2013, 22(2): 192-196.

1. Zhang BS. About disputing of treatment cholecystolithiasis and discussion with the theory of Langenbuch[J]. Chin J Med, 2007, 42(5): 1-4.
2. 赵庆峰, 白文坤.超声引导下经皮经肝胆囊穿刺引流治疗急性梗阻性胆囊炎20例分析[J].齐鲁医学杂志, 2012, 27(6): 538-539.
3. Flum DR, Cheadle A, Prela C, et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries[J]. JAMA, 2003, 290(16): 2168-2173.
4. Spanos C P, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review[J]. Langenbecks Arch Surg, 2006, 391(5): 441-447.
5. 邹宏雷, 张都民, 杜鹃.腹腔镜胆囊切除术中的复杂情况及处理对策[J].中国普外基础与临床杂志, 2012, 19(2): 204-207.
6. Spira RM, Nissan A, Zamir O, et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis[J]. Am J Surg, 2002, 183(1): 62-66.
7. 杜冬, 崔忠, 孙建斌, 等.经皮经肝胆囊穿刺置管引流治疗老年重症急性胆囊炎[J].临床误诊误治, 2012, 25(2): 78-79.
8. 王宏, 罗建管, 梁鹏, 等.腹腔镜胆囊切除术胆管损伤危险因素分析[J].中国实用外科杂志, 2011, 31(7): 591-593.
9. 文君, 肖渝清, 张抒, 等.急诊腹腔镜胆囊切除与急诊开腹胆囊切除术的临床对照研究[J].中国普外基础与临床杂志, 2013, 20(2): 195-198.
10. Huang CC, Lo HC, Tzeng YM, et al. Percutaneous transhepatic gallbladder drainage: a better initial therapeutic choice for patients with gallbladder perforation in the emergency department[J]. Emerg Med J, 2007, 24(12): 836-840.
11. 李正起, 陈灵丽. PTGD治疗急性胆囊炎的临床疗效观察[J].海南医学院学报, 2012, 18(1): 71-73.
12. 赵龙, 钱建军, 柏斗胜.经脐单孔腹腔镜胆囊切除术的学习曲线研究[J].中国现代普通外科进展, 2013, 16(4): 282-289.
13. 林叶, 金浩生, 简志祥.经脐单孔腹腔镜与传统腹腔镜治疗胆囊良性疾病的对比研究[J].南方医科大学学报, 2013, 33(8): 1199-1202.
14. 陈伟荣, 李佩球, 章庆华.经脐单孔腹腔镜胆囊切除术临床应用体会[J].中国内镜杂志, 2013, 18(8): 875-876.
15. 袁德汉, 陈应军, 卫洪波.腹腔镜胆囊切除术所致胆道损伤的相关危险因素分析[J].中国内镜杂志, 2013, 19(5): 492-495.
16. 谷化剑, 冯贤松, 辛小燕.医源性胆道损伤的原因分析与防治策略[J].中国普通外科杂志, 2013, 22(2): 192-196.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases)

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