摘要
目的分析超声引导下经皮经肝胆囊穿刺引流术(PTGD)治疗高龄急性胆囊炎的临床效果及安全性。方法27例高龄急性胆囊炎患者均接受PTGD治疗,观察两组手术基本情况、炎症因子水平、临床表现改善时间及胃肠功能恢复进程,并统计并发症或不良事件发生情况。结果 27例高龄患者手术时间为(33.15±11.07)min,失血量为(28.98±6.23)ml,术后抗生素应用时间(4.11±1.23)d;且术间仅出现2(7.41%)中转开腹的情况。所有患者术后促炎细胞因子血清白介素-2(IL-2),抗炎细胞因子白介素-4(IL-4)水平与术前相比均明显改善(P<0.05)。术后体温恢复时间、腹膜炎症状改善时间、白细胞恢复时间及凝血功能恢复时间依次为(3.15±1.07)h、(8.98±3.23)h、(5.63±2.29)h、(9.11±2.83)h,术后肠鸣音恢复时间、肛门排气时间、排便时间及固体食物进食时间依次为(12.70±3.41)h、(24.01±4.62)h、(40.45±6.65)h、(105.16±15.02)h。27例高龄患者术后出现2例(7.41%)出血,未出现其他并发症及死亡病例。结论 PTGD有助于促进急性胆囊炎患者术后临床症状改善、胃肠功能恢复,可有效减轻机体炎症反应,且并发症少,安全性高,高龄患者可耐受。
Objective To analyze the clinical efficacy and safety of ultrasound-guided percutaneous transhepatic gallbladder drainage（ PTGD） in the treatment of acute cholecystitis in elderly patients. Methods 27 cases of patients with acute cholecystitis were given the PTGD. The operation basic conditions,the inflammatory factors levels,the clinical manifestation improvement time and the recovery course of gastrointestinal function were observedin the two groups,and the complications or adverse events were also counted.Results The operative time,the blood loss and the postoperative antibiotic application time were（ 33. 15 ± 11. 07） min,（ 28. 98 ±6. 23） ml and（ 4. 11 ± 1. 23） d in the 27 cases of elderly patients. And only 2 cases（ 7. 41%） were converted to open laparotomy during operation. Thelevels of pro-inflammatory cytokineserum interleukin-2（ IL-2） andthe anti-inflammatory cytokine interleukin-4（ IL-4） after operation were significantly higher than those before operation（ P 0. 05）. The postoperative recovery time of body temperature,peritonitis symptom improvement time,the recovery times of white blood cell and coagulation function were（ 3. 15 ± 1. 07）h,（ 8. 98 ± 3. 23） h（ 5. 63 ± 2. 29） h and（ 9. 11 ± 2. 83） h respectively. The postoperative bowel sound recovery time,anal exhaust time,defecation time and solid food intake time were（ 12. 70 ± 3. 41） h,（ 24. 01 ± 4. 62） h,（ 40. 45 ± 6. 65） h and（ 105. 16 ±15. 02） h. There were 2 cases（ 7. 41%） with bleeding and no other complications and death cases in the 27 cases of elderly patients after operation. Conclusions PTGD is conducive to promote the postoperative clinical symptoms and gastrointestinal function recovery,and effectively reduce the body＇s inflammatory response with fewer complications and high safety in treatment of patients with acute cholecystitis,and it can be tolerated by elderly patients.
出处
《肝胆外科杂志》
2017年第5期378-381,共4页
Journal of Hepatobiliary Surgery
关键词
超声引导下经皮经肝胆囊穿刺引流术
高龄
急性胆囊炎
效果
安全性
ultrasound-guided percutaneous transhepatic gallbladder drainage
elderly
acute cholecystitis
effects
safety
