经皮经肝胆囊穿刺引流联合腹腔镜下左侧入路胆囊切除治疗急性重症胆囊炎老年患者的临床疗效

Clinical efficacy of percutaneous transhepatic gallbladder drainage combined with left side of laparoscopic cholecystectomy in elderly patients with acute severe cholecystitis

摘要:

目的 探讨经皮经肝胆囊穿刺引流（PTGD）联合腹腔镜下左侧入路胆囊切除治疗急性重症胆囊炎老年患者的临床疗效。方法 选择2016年10月－2019年12月于该院住院并接受治疗的急性重症胆囊炎老年患者80例，均行彩超引导下PTGD联合腹腔镜下左侧入路胆囊切除治疗。观察患者术中情况、术后恢复和并发症发生情况。结果 80例患者均1次胆囊穿刺成功，术后所有患者临床症状迅速缓解，无胆囊穿刺相关并发症发生。所有患者待30 d～3个月后行腹腔镜下左侧入路胆囊切除术，均无中转开腹，未发生术中胆囊动脉主干破裂出血、术后腹腔出血和胆漏等并发症。结论 PTGD能够简单、有效地缓解急性重症胆囊炎老年患者的临床症状。择期行腹腔镜下左侧入路胆囊切除术可避免中转开腹，减少术中出血及术后并发症，安全可靠，值得临床推广应用。

Abstract:

Objective To investigate the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGD) combined with laparoscopic left-side cholecystectomy in the treatment of acute severe cholecystitis in the elderly.Methods Selected 80 elderly patients with acute severe cholecystitis from October 2016 to December 2019, all these patients underwent PTGD under the guidance of color Doppler ultrasound combined with laparoscopic left approach to the gallbladder resection treatment. Observe the patient’s intraoperative conditions, postoperative recovery, and complications.Results All the 80 patients were successful in once gallbladder puncture. After the gallbladder puncture and drainage, the clinical symptoms of all patients were relieved quickly, and there were no complications related to gallbladder puncture. All the patients underwent laparoscopic left-side cholecystectomy after 30 d to 3 months. There was no conversion to laparotomy, no intraoperative rupture and bleeding of the main cholecystic artery, and no postoperative complications such as abdominal hemorrhage and biliary fistula.Conclusion PTGD can simply and effectively relieve the clinical symptoms of elderly patients with acute severe cholecystitis. Elective laparoscopic cholecystectomy with the left side approach can reduce conversion to laparotomy, intraoperative bleeding and postoperative complications. It is safe and reliable, and is worthy of clinical application.