目的 评价B超引导下经皮经肝胆囊穿刺引流术（PC）治疗老年急性重症胆囊炎的效果。方法 18例重症胆囊炎的老年患者接受了在局部麻醉下经皮经肝穿刺胆囊置管引流。结果 所有患者穿刺置管成功，无一例发生并发症，且症状及体征均于术后24～48 h明显改善。结论 PC是一种微创、有效、廉价、可靠的治疗老年急性重症胆囊炎的方法。
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。
ObjectiveTo explore the curative effect and the appropriate time of sequentially with minimal invasive methods in treatment of elderly acute calculous cholecystitis patients combined with organ dysfunction syndrome (ODS). MethodsClinical data of 67 elderly acute calculous cholecystitis patients combined with ODS who received treatment in our hospital from December 2010 to December 2013 were collected retrospectively. All of the 67 patients were treated with percutaneous transhepatic gallbladder drainage (PTGBD) under the guidance of B ultrasound or CT at first, as well as systemic anti infective therapy, and then underwent laparoscopic cholecystectomy (LC) sequentially when situation of body got well. ResultsAll of the 67 patients (100%) were treated with PTGBD successfully, but only 65 patients finished the latter related test. For the 65 patients, compared with before PTGBD, the patient's pain, abdominal distention, vomiting, leukocyte count, neutrophil ratio, glutamic-pyruvic transaminase, total bilirubin, C-reactive protein, and temperature had gotten obviously better on 1 and 4 d after PTGBD (P<0.05). There were 3 patients dropped LC, 2 patients transferred to mini-incision cholecystectomy, and the rest of 60 patients underwent LC successfully. All of the patients recovery and discharged from hospital in 2-7 days after operation. ConclusionSequentially mini-invasive method is a simple, easy, safe, effective, mini trauma, and quick recovery method for the elderly acute cholecystitis patients combined with the ODS.
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.