吴鸣 马保金

摘 要 目的：探讨超声引导下经皮经肝胆囊穿刺置管引流术(PTGBD)联合腹腔镜胆囊切除（LC）在高危老年急性胆囊炎患者中的疗效。方法：收集65例高危老年人急性胆囊炎患者（APACHE≥12），在超声引导下经肝组织穿刺入胆囊腔后引流，2-3月后行腹腔镜胆囊切除术。结果：65例患者均成功行经皮肝胆囊抽吸术，1例导管滑脱出现轻度胆漏，其余均引流通畅症状缓解，择期行胆囊切除术，无严重并发症。结论：PTGBD结合LC是一种安全、有效地把急诊胆囊手术变成择期胆囊手术的方法。

关键词老年病人急性胆囊炎APACHEII经皮肝胆囊引流术

中图分类号：657.4文献标识码：C文章编号：1006-1533（2012）12-0025-03

The application of percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in high-risk elderly patients with acute cholecystitis

WU Ming1, MA Bao-jin2

（1.Department of Surgery, Tinglin Hospital, Shanghai, 201505;

2. Department of Surgery, Huashan Hospital, Fudan University, ShangHai, 200040）

ABSTRACTObjective: To study the effectiveness of percutaneous transhepatic gallbladder drainage（PTGBD）and laparoscopic cholecystectomy (LC) under the ultrasound-guidance in high-risk elderly patients with acute cholecystitis. Method：The study collected 65 high-risk elderly patients with acute cholecystitis, whose APACHE II score over 12. PTGBD guided by US were successfully drainaged through the liver tissue puncture into the gallbladder lumen, and after 2～3 months the laparascopic cholecystectomy was performed. Results: PTGBD was successful in 65 cases and released the symptom of acute cholecystitis. One patient was fault because of the catheter slippage. Cholecystectomy was operated and no severe complications were observed in 65 patients. Conclusion: PTGBD combined with LC is a safe and effective method that can turn emergent operation into selective operation.

KEY WORDSelderly patient；acute cholecystitis；APACHE II；PTGBD

急性胆囊炎是老年人常见的外科急腹症，随着生活水平提高、饮食结构改善和寿命延长，发病率呈增长趋势。由于老年患者机体处于衰退状态，往往合并心肺等脏器功能不全，对疾病反应能力低下，病情变化快容易出现连锁反应，处理起来十分棘手，手术的并发症很高，最高可大于30%[1,2]。近年来损伤控制理论在外科领域逐步受到重视，因此结合该理念，我们对于高危老年急性胆囊炎患者采用B超引导下经皮经肝胆囊引流术（percutaneous transhepatic gallbladder drainage，PTGBD)达到降低胆囊压力，控制急性炎症的目的，使需要急诊行胆囊手术的病人经引流后症状缓解，进而可择期行腹腔镜胆囊切除术，最终大大降低手术风险[3-5]。我们筛选出APACHE II 评分≥12的高危老年急性胆囊炎患者经皮经肝胆囊引流术，2-3月后行腹腔镜胆囊切除，评价其效果和风险。

1对象与方法