超声联合透视引导经皮穿刺引流治疗急性胆囊炎.pdf

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1、中国临床医学影像杂志2013年第24卷第l1期JChinClinMedImaging，2013，Vo1．24，No．11·777·超声联合透视引导经皮穿刺引流治疗急性胆囊炎周大昕，畅智慧，马羽佳，赵健，刘兆玉(中国医科大学附属盛京医院放射科，辽宁沈阳110004)[摘要】目的：评估经皮穿刺引流治疗急性胆囊炎患者的安全性及有效性。方法：回顾性分析2009-2013年我院118例有急诊胆囊切除禁忌的急性胆囊炎患者在超声联合透视引导下行胆囊穿刺引流术(Percutaneoustranshepaticgallbladderdrainage，PTGD)。其中急性结石性胆囊炎患者66例，急性非

2、结石性胆囊炎患者52例，通过对比术前、术后实验室、影像学检查及临床症状的改善评价疗效。结果：l18例患者中l16例为一次性置管成功，有2例患者为二次置管成功。66例急性结石性胆囊炎患者中，45例炎症痊愈，择期行胆囊切除术，12例不能耐受手术患者无症状长期置管，脱管4例，死亡5例。52例非结石性胆囊炎患者中，44例于引流后3-4周透视下行胆道造影示无梗阻后拔管康复，脱管5例，长期带管2例，死亡1例。结论：超声联合透视引导PTGD治疗急性胆囊炎是一种简单、安全而有效的治疗方法，且非结石性胆囊炎患者采用穿刺引流后的预后效果较结石性胆囊炎患者的预后更为显著。【关键词】胆囊炎，急性；胆囊造影

3、术；超声检查，介入性[中图分类号】R657．41；R814．43；R815[文献标识码】A【文章编号】1008—1062(2013)11-0777—03PercutaneousdrainageinthetreatmentofacutecholecystitisundertheguidanceofultrasoundcombinedwithfluoroscopyZHOUDa-xin,CHANGZhi—hui，MAYu--jia,ZHA0tan，LIUZhao-yu(DepartmentofRadiology,ShengfingHospitalofChinaMedicalUnivers

4、ity,Shenyang110004,China)Abstract：Objective：Toevaluatethesafetyandefficacyinthetreatmentofpereutaneousgallbladderdrainage(PTGD)foracutecholecystitisundertheguidanceofultrasoundcombinedwithfluoroscopy．Methods：From2009through2013，118casesofacutecholecystitiswhowerecontraindicatedtohavecholecyste

5、ctomyatthetimeofadmissionandweretreatedwithPTGDundertheguidanceofultrasoundcombinedwithX—rayfluoroscopy．Amongthesepat!ents，66caseswereacutecalcu—louscholecystitis，52caseshadnon—calculouschole,cystitis．Thepreoperativeandpostoperativeclinicalsymptoms，laboratorytests，radiologicexaminationswereeva

6、luatedandcompared．Results：Theinsertionofthedisposabledrainagecatheterwassucceededin116casesatthefirsttechnicaltrialandin2patientsitwassucceededbythesecondtria1．Amongthe66cas—esofacutecalculouscholecystitiscases，45cases(68．2％)werecompletelyrecoveredhadcholecystectomythereafter，12asym—tomaticcas

7、es(18．18％)whocouldnottoleratesurgeryandweregivenlong-termcatheterization，drainagecatheterdetachedin4cases(6．0％)，5cases(7．6％)died．Whileinthe52casesofnon—cauculouscholecystitis，afterdrainagefor3-4weeks，cholan—giographyshowedthat44cases(84