Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 于浩 , 劉武 , 姜洪磊 , 金俊哲 ,  梁健

中國醫科大學附屬第四醫院肝膽外科（遼寧沈陽 110032）;

Corresponding?author：

梁健, Email: liangj63110@vip.sina.Com

Keywords：

經皮經肝膽囊穿刺; 腹腔鏡膽囊切除術; 急性重癥膽囊炎

DOI：

10.7507/1007-9424.20140228

Video：

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目的探討超聲引導下經皮經肝膽囊穿刺引流術（PTGD）聯合二期腹腔鏡膽囊切除術（LC）治療急性膽囊炎的安全性和可行性。方法回顧性分析我院2008年7月至2013年7月期間對急性膽囊炎先行PTGD后二期LC的117例患者的臨床資料。結果本組117患者PTGD術后均成功實施二期LC，PTGD術順利，無并發癥發生，PTGD管平均留置時間27.4 d（21～31 d）。LC采用單孔法33例，三孔法84例，全部病例均治愈。手術平均時間為48.5 min（32～92 min），腹腔引流管拔除平均時間為2.3 d（2～4 d）。無中轉開腹者，無膽管損傷、出血、膽汁漏等并發癥發生。病理結果為急性膽囊炎。本組隨訪患者無術后并發癥。結論超聲引導下PTGD聯合二期LC治療急性膽囊炎安全、有效。

Citation： 于浩, 劉武, 姜洪磊, 金俊哲, 梁健. Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(8): 951-953. doi: 10.7507/1007-9424.20140228 Copy

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2.	趙慶峰, 白文坤.超聲引導下經皮經肝膽囊穿刺引流治療急性梗阻性膽囊炎20例分析[J].齊魯醫學雜志, 2012, 27(6): 538-539.
3.	Flum DR, Cheadle A, Prela C, et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries[J]. JAMA, 2003, 290(16): 2168-2173.
4.	Spanos C P, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review[J]. Langenbecks Arch Surg, 2006, 391(5): 441-447.
5.	鄒宏雷, 張都民, 杜鵑.腹腔鏡膽囊切除術中的復雜情況及處理對策[J].中國普外基礎與臨床雜志, 2012, 19(2): 204-207.
6.	Spira RM, Nissan A, Zamir O, et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis[J]. Am J Surg, 2002, 183(1): 62-66.
7.	杜冬, 崔忠, 孫建斌, 等.經皮經肝膽囊穿刺置管引流治療老年重癥急性膽囊炎[J].臨床誤診誤治, 2012, 25(2): 78-79.
8.	王宏, 羅建管, 梁鵬, 等.腹腔鏡膽囊切除術膽管損傷危險因素分析[J].中國實用外科雜志, 2011, 31(7): 591-593.
9.	文君, 肖渝清, 張抒, 等.急診腹腔鏡膽囊切除與急診開腹膽囊切除術的臨床對照研究[J].中國普外基礎與臨床雜志, 2013, 20(2): 195-198.
10.	Huang CC, Lo HC, Tzeng YM, et al. Percutaneous transhepatic gallbladder drainage: a better initial therapeutic choice for patients with gallbladder perforation in the emergency department[J]. Emerg Med J, 2007, 24(12): 836-840.
11.	李正起, 陳靈麗. PTGD治療急性膽囊炎的臨床療效觀察[J].海南醫學院學報, 2012, 18(1): 71-73.
12.	趙龍, 錢建軍, 柏斗勝.經臍單孔腹腔鏡膽囊切除術的學習曲線研究[J].中國現代普通外科進展, 2013, 16(4): 282-289.
13.	林葉, 金浩生, 簡志祥.經臍單孔腹腔鏡與傳統腹腔鏡治療膽囊良性疾病的對比研究[J].南方醫科大學學報, 2013, 33(8): 1199-1202.
14.	陳偉榮, 李佩球, 章慶華.經臍單孔腹腔鏡膽囊切除術臨床應用體會[J].中國內鏡雜志, 2013, 18(8): 875-876.
15.	袁德漢, 陳應軍, 衛洪波.腹腔鏡膽囊切除術所致膽道損傷的相關危險因素分析[J].中國內鏡雜志, 2013, 19(5): 492-495.
16.	谷化劍, 馮賢松, 辛小燕.醫源性膽道損傷的原因分析與防治策略[J].中國普通外科雜志, 2013, 22(2): 192-196.

1. Zhang BS. About disputing of treatment cholecystolithiasis and discussion with the theory of Langenbuch[J]. Chin J Med, 2007, 42(5): 1-4.
2. 趙慶峰, 白文坤.超聲引導下經皮經肝膽囊穿刺引流治療急性梗阻性膽囊炎20例分析[J].齊魯醫學雜志, 2012, 27(6): 538-539.
3. Flum DR, Cheadle A, Prela C, et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries[J]. JAMA, 2003, 290(16): 2168-2173.
4. Spanos C P, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review[J]. Langenbecks Arch Surg, 2006, 391(5): 441-447.
5. 鄒宏雷, 張都民, 杜鵑.腹腔鏡膽囊切除術中的復雜情況及處理對策[J].中國普外基礎與臨床雜志, 2012, 19(2): 204-207.
6. Spira RM, Nissan A, Zamir O, et al. Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis[J]. Am J Surg, 2002, 183(1): 62-66.
7. 杜冬, 崔忠, 孫建斌, 等.經皮經肝膽囊穿刺置管引流治療老年重癥急性膽囊炎[J].臨床誤診誤治, 2012, 25(2): 78-79.
8. 王宏, 羅建管, 梁鵬, 等.腹腔鏡膽囊切除術膽管損傷危險因素分析[J].中國實用外科雜志, 2011, 31(7): 591-593.
9. 文君, 肖渝清, 張抒, 等.急診腹腔鏡膽囊切除與急診開腹膽囊切除術的臨床對照研究[J].中國普外基礎與臨床雜志, 2013, 20(2): 195-198.
10. Huang CC, Lo HC, Tzeng YM, et al. Percutaneous transhepatic gallbladder drainage: a better initial therapeutic choice for patients with gallbladder perforation in the emergency department[J]. Emerg Med J, 2007, 24(12): 836-840.
11. 李正起, 陳靈麗. PTGD治療急性膽囊炎的臨床療效觀察[J].海南醫學院學報, 2012, 18(1): 71-73.
12. 趙龍, 錢建軍, 柏斗勝.經臍單孔腹腔鏡膽囊切除術的學習曲線研究[J].中國現代普通外科進展, 2013, 16(4): 282-289.
13. 林葉, 金浩生, 簡志祥.經臍單孔腹腔鏡與傳統腹腔鏡治療膽囊良性疾病的對比研究[J].南方醫科大學學報, 2013, 33(8): 1199-1202.
14. 陳偉榮, 李佩球, 章慶華.經臍單孔腹腔鏡膽囊切除術臨床應用體會[J].中國內鏡雜志, 2013, 18(8): 875-876.
15. 袁德漢, 陳應軍, 衛洪波.腹腔鏡膽囊切除術所致膽道損傷的相關危險因素分析[J].中國內鏡雜志, 2013, 19(5): 492-495.
16. 谷化劍, 馮賢松, 辛小燕.醫源性膽道損傷的原因分析與防治策略[J].中國普通外科雜志, 2013, 22(2): 192-196.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined Laparoscopic Cholecystectomy in Treatment of Severe acute Cholecystitis(Report of 117 Cases)

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