ptgd在高龄高危急性胆囊炎中的应用.docVIP

PTGD在高龄高危急性胆囊炎中的应用 　　[摘要] 目的 探究经皮经肝胆囊穿刺引流术（pereutaneous transatlantic gallbladder drainage，PTGD）在高龄高危急性胆囊炎中的应用效果。 方法 方便选取 2013年12月―2016年12月收治的65例曾在该院就诊的患有高危急性胆囊炎的老年患者临床资料进行分析。 结果 65例患者全部一次性置管成功，无死亡病例。65例病例中，64例一次性治愈，1例由于置管堵塞，进行二次性置管，最终情况和其余64例相同。65例患者在1.5，2及3年进行随访，患者无症状出现。并且在1～4个月内实施了腹腔镜胆囊切除术，开腹手术或经窦道胆道镜胆囊结石液电碎石取石术等手术，并成功完成。结论 对于高龄高危的急性胆囊炎患者先进行经皮经肝胆囊穿刺引流，然后择期进行腹腔镜胆囊切除术等手术是一项安全可靠，简单有效的治疗方式。 　　[关键词] 高龄高危；急性胆囊炎；经皮经肝胆囊穿刺引流术（PTGD） 　　[中图分类号] R657 [文献标识码] A [文章编号] 1674-0742（2017）03（b）-0012-03 　　[Abstract] Objective To study the application effect of pereutaneous transatlantic gallbladder drainage in the senile and high-risk acute cholecystitis. Methods Convenient selection The clinical data of 65 cases of senile and high-risk acute cholecystitis patients diagnosed in our hospital from December 2013 to December 2016 were analyzed. Results The one-time inserting success rate of 65 cases was 100.00%， and there were no death cases， in the 65 cases， 64 cases were cured by one-time and 1 case was with tube obstruction， and the second tube showed the same results， and the patients had no symptoms after 1.5-year， 2-year and 3-year follow up， and the patients were given the laparoscopic cholecystectomy， open surgery or cholecystolithiasis electrohydraulic lithotripsy by sinus tract biliary tract endoscope and the operations were successfully finished. Conclusion For senile and high-risk acute cholecystitis patients， we should firstly conduct the percutaneous transhepatic gallbladder drainage and then conduct the laparoscopic cholecystectomy， which is a safe， reliable， simple and effective treatment method. 　　[Key words] Senile high-risk； Acute cholecystitis； Pereutaneous transatlantic gallbladder drainage 　　高危急性?囊炎（AC）是指由于胆囊管腔阻塞并且伴随细菌入侵而引发的一种最为常见的急性胆囊炎症疾病，它是胆囊切除手术的绝对手术指征，这种病的主要临床表现是右上腹阵发性绞痛，伴有腹肌强直以及强烈的触痛症状[1]。随着人口老龄化人数逐渐增多，高龄的人群中患有急性胆囊炎的人数也越来越多。如今，更令人不愿意看到的是，高危急性胆囊炎患者常常伴随其他的合并症状同时出现，如由于管壁增厚，管腔狭窄等原因造成的动脉粥样硬化性心脏病及冠心病，有的还伴有心律失常，肾功能衰竭，高血压，呼吸衰竭等并发症[2]。更有甚者，有的老年胆石症患者还伴随着化脓性胆囊炎和化脓性