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題 名 | Ultrasound-guided Percutaneous Transhep-atic Drainage of Gallbladder Followed by Cholecystectomy for Acute Cholecystitis-10 Years' Experience=以超音波誘導經皮穿肝膽囊引流作為急性膽囊炎的初步治療方法-10年臨床經驗 |
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作 者 | 王森稔; 李金德; 郭功楷; 陳榮祥; 柯成國; 沈柏青; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 14:1 1998.01[民87.01] |
頁 次 | 頁19-24 |
分類號 | 416.247 |
關鍵詞 | 超音波; 經皮穿肝膽囊引流; 急性膽囊炎; Cholecystitis; Cholangiography; Percutaneous cholecystostomy; |
語 文 | 英文(English) |
中文摘要 | 急性膽囊炎是一種常見的疾病,病人本身也可能同時有其它併發症,如:膽囊化膿、膽囊穿孔、腹膜炎及敗血症等。經皮穿肝膽囊引流術合併抗生素使用,可以很快地把感染的膽汁引流體外,令臨床症狀得以快速改善,同時有效地阻止膽囊炎繼續進行。從1986年7月到1996年6月,我們一共收集154個急性膽囊炎的病例。這些病人在急性膽囊炎的診斷確立後,即在超音波的誘導及局部麻醉下,經由肝臟膽囊床進行膽囊穿刺引流。幾乎所有病人其臨床症狀,都能在術後短時間內迅速改善。引流出的膽汁經細菌培養後,可發現培出菌以大腸菌為最多,而膽汁細菌培養率為67.5%。有138位病人於急性期後,經由引流管進行膽道攝影,其結果可幫助瞭解整個膽道系統的情形,最重要的是減少殘餘總膽管結石的可能性。有135位病人在病況穩定後,接受手術治療,術後併發症發生率是9.6 %,而死亡率為0.7 %,比先前研究報告者為低。我們的結論是,以經皮穿肝膽囊引流術作為急性膽囊炎的初步治療方法,可有效降低手術後併發症發生率及死亡率。 |
英文摘要 | Acute cholecystitis is a common disease which may carry the risk of complications, including empyema, perforation, abscess, peritonitis and sepsis. Percutaneous transhepatic drainage of the gallbladder (PTGBD) with antibiotics can provide prompt decompression of gallbladder in acute cholecystitis and interrupt the natural history of the disease effectively. From July 1986 to June 1996, 154 patients with acute cholecystitis were reviewed retrospectively in Kaohsiung Medical College Hospital. The chief symptoms and signs were pain (98.1%), fever (57.1%) and jaundice (37.7%). WBC count more than 10,000 was noted in 116 (75.3%) patients. Associated diseases included empyema: 42 (27.3%), septic shock: 14 (9.1%), diabetes mellitus: 13 (8.4%), pancreatitis: 10 (6.5%) perforation: 7 (4.5%), liver cirrhosis: 6 (3.9%) and respiratory failure: 1 (0.6%). All of them underwent ultrasound-guided PTGBD immediately after the diagnosis was established. The symptoms and signs disappeared soon after this procedure. Bacterial culture was found positive in 104 (67.5%) of 154 patients in which Escherichia coIl (51.9%) was the most common organism, followed by Klebsiella pneumonia (20.2%). After acute stage, 138 patients obtained the cholangiography via PTGBD tube. Gallbladder stones were only noted in 56 (40.6%) patients, gallbladder stone concomitant with common bile duct stone in 26 (18.8%), cystic duct obstruction in 25 (18.1%) acalculous cholecystitis in 21 (15.2%), gallbladder perforation in 1 (0.7%), choledochocyst in 1 (0.7%), and cholecystocolonic fistula in 1 (0.7%). There were 135 patients to undergo surgery after the clinical condition was stable. The operative findings included gallbladder stones only in 88 (65.2%), gallbladder stone concomitant with common bile duct stone in 34 (25.2%), acalculous cholecystitis in 13 (9.6%), choledochocyst in 1 (0.7%), and cholecysto-colonic fistula in 1 (0.7%). The postoperative complications included wound infection 8 (5.9%), UGI bleeding 3 (2.2%), acute renal failure 1 (0.7%) and acute respiratory failure 1 (0.7%). The postoperative mortality rate was 0.7% (1/135), which was much lower than those of previous reports, which not undergoing PTGBD initially. It led us to conclude that PTGBD, as an initial preoperative modality to treat acute cholecystitis, is effective in decreasing postoperative morbidity and mortality. |
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