摘要
目的:探讨急诊超声引导下经皮经肝胆囊穿刺置管引流术(PTGBD)治疗合并感染性休克的急性梗阻性化脓性胆管炎(AOSC)的疗效及安全性。方法:对我院2013-01—2018-01期间收治的32例经急诊超声引导下PTGBD治疗的合并感染性休克的AOSC患者进行回顾性分析。结果:32例患者均成功穿刺置管,未出严重并发症,术后出现导管堵塞1例。穿刺引流后24h、72h、7d复查WBC、PCT、CRP、TBIL、ALT、ALP、GGT、T、VAS等可见显著下降(P<0.05)。穿刺时胆汁培养的阳性率显著高于穿刺前血培养阳性率(P<0.05)。其中,4例患者死于感染性休克和MODS,23例患者在病情改善后,根据胆道梗阻原因行手术治疗,疗效满意,5例患者带管出院。结论:对合并感染性休克的AOSC患者,急诊超声引导下PTGBD治疗可以及时解除胆道梗阻,且具有创伤小、操作简便的优点,是一种安全可行的治疗方法。
Objective：To explore the efficacy and safety of emergency ultrasound-guided percutaneous transpepatic gallbladder dramage（PTGBD）for acute obstructive suppurative cholangitis（AOSC）patients combined with septic shock.Method：The clinical data of thirty-two patients with acute obstructive suppurative cholangitis combined with septic shock in our hospital from January 2013 to January 2018 were reviewed retrospectively.Those patients were all treated with emergency ultrasound-guided percutaneous transpepatic gallbladder dramage.Result：All thirty-two patients were successfully punctured,and there was no serious complications.In one case,the catheter was blocked.After 24 hours,72 hours and 7 days of PTGBD,each index statistically decreased,including white blood cell,procalcition,C-reactiveprotein,total bilirubin,Alanine transaminase,A Lkaline Phosphatase,gamma-glutamyl transpeptidase,temperature,visual analogue score.The positive rate of bile culture during puncture was significantly higher than that of blood culture before puncture.There were four patients who died of septic shock and MODS.After improvement,twenty-three patients underwent surgical treatment according to the cause of biliary obstruction,and the curative effect was satisfactory.Five patients were discharged with catheter.Conclusion：For the patients with acute obstructive suppurative cholangitis combined with septic shock,emergency ultrasound-guided percutaneous transpepatic gallbladder dramage can remove biliary tract obstruction in time,and has the advantages of small trauma and simple operation,which is a safe and feasible treatment.
作者
丁伟超
许铁
燕宪亮
叶英
任泽强
张蓬波
吕建农
DING Weichao;XU Tie;YAN Xianliang;YE Ying;REN Zeqiang;ZHANG Pengbo;LV Jiannong(Emergency Center,the Affiliated Hospital of Xuzhou Medical University,Jiangsu,Xuzhou,221000,China;Pancreatic Surgery,the Affiliated Hospital of Xuzhou Medical University)
出处
《临床急诊杂志》
CAS
2018年第7期460-462,共3页
Journal of Clinical Emergency
