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目的探讨超声引导下经皮经肝胆囊穿刺置管引流治疗老年高危急性胆囊炎患者的有效性和安全性。方法对收治的20例年龄在62岁-91岁的老年重症急性胆囊炎患者行PTGD,观察临床治疗效果。本组急性结石性胆囊炎15例,急性非结石性胆囊炎5例;20例患者均有1种或多种伴随疾病。结果 20例患者均穿刺置管成功,全部获得有效胆囊引流,引流后3天-5天内症状、体征缓解,体温恢复正常。15例胆囊结石患者中,12例于2月内顺利完成腹腔镜或开腹胆囊切除术,术中拔除胆囊引流管;8例未手术患者于2月内顺利拔除胆囊引流管。本组患者无胆漏、出血、血气胸、消化道损伤等并发症发生。结论对于高危老年急性胆囊炎患者,PTGD是一种安全、微创、有效的治疗方法,能够起到较好的控制急性感染、度过危险期的作用。
Objective To investigate the effectiveness and safety of percutaneous transhepatic cholecystic drainage under the guidance of ultrasound in the treatment of elderly patients with acute cholecystitis. Methods Twenty patients with severe acute cholecystitis aged 62-91 years old underwent treatment of PTGD to observe the clinical effect. The group of 15 cases of acute calculous cholecystitis, acute acalculous cholecystitis in 5 cases; 20 patients had one or more with the disease. Results Twenty patients underwent puncture and catheterization successfully. All patients received effective gallbladder drainage. Symptoms and signs were relieved within 3 days and 5 days after drainage. The body temperature returned to normal. Of the 15 patients with gallstones, 12 successfully completed laparoscopic or open cholecystectomy within 2 months, and the gallbladder drainage tube was removed during operation. Eight patients who did not undergo surgery successfully removed the gallbladder drainage tube within 2 months. The patients without bile leakage, bleeding, pneumothorax, gastrointestinal injury and other complications. Conclusions PTGD is a safe, minimally invasive and effective treatment for elderly patients with acute cholecystitis at high risk. It can play a better role in controlling acute infection and getting through dangerous period.