PT在老年急性重症胆管炎治疗中的临床观察.docVIP

PTCD在老年急性重症胆管炎治疗中的临床观 郑州大学附属郑州中心医院肝胆胰外科郑州450007 目的观察经皮肝穿刺胆道引流术(PTCD)在老年急性重症胆 管炎中的治疗效果。方法回顾分析2013年01月到2015年05月在我院行PTCD 治疗的35例老年急性重症胆管炎患者的临床资料，观察临床治疗效果。结果35 例PTCD的老年急性重症胆管炎患者均穿刺置管成功，全部获得有效胆管引流， 引流12?36h后腹痛明显减轻，体温逐渐降至正常。术后肭道出血2例，胆 漏1例，无导管脱落、胆管阻塞、气胸、血胸等并发症及死亡病例。结论对难 以耐受手术的老年急性重症胆管炎患者，PTCD是一种可靠、安全、有效、微创 的治疗方法。 关键词：经皮肝穿刺胆道引流术；急性重症胆管炎；老年 Observation of treatment effect of percutaneous transhepatic biliary drainage on acute severe cholangitis Liang Zhanqiang, Li Xuemin, Wang Zhongzhen, Duan Xibin Yang Pengsheng (Department of hepatopanceatobiliary，Zhengzhou surgery Central Hospital Affiliated to Zhengzhou University，Zhengzhou 450007 China?) ABSTRACT Objective: To observe the treatment effect of percutaneous transhepatic cholangio drainage (PTCD) on acute severe cholangitis in the elderly patients under guidance of Color Doppler-ultrasound. Methods: In our hospital, 55 cases of elderly patients with acute severe cholangitis were treated with PTCD and their clinical treatment results were analyzed. Results: All the cases succeeded in puncture and catheterization, and got effective biliary drainage. After 12 to 36 hours all of the abdominal pain was relieved, and all of the body temperature gradually returned to normal. Among them, 2 cases were biliary tract hemorrhage, 1 case was bile leakage, There were no catheter shedding, bile duct obstruction, pneumothorax, hemothorax, complications and deaths. Conclusion: PTCD is a safe, reliable, minimally invasive and effective treatment method for the elderly patients with acute severe cholangitis who were difficult to tolerate any operations. KEY WORDS PTCD; acute severe cholangitis; elderly. 急性重症胆管炎(acute cholangitis of severe type, ACST)是一种 临床常见的疾病，该疾病常因胆道梗阻和细菌感染、胆道内压升高、胆血流屏障 受损、大量细菌和毒素移位进入血循环、引起以肝胆系统受损为主，合并多个脏 器损害的全身严重感染性疾病，具奋起病急骤、病情凶险、进展快、易并发感染 性休克和多脏器功能衰竭的特点［1］，有学者［2】报道急性重症胆管炎保守治疗死 亡率可达100%。特别是老年患者多伴冇多种基础疾病，如高血压、糖尿病、冠 状动脉粥样硬化性心脏病、脑梗死等等，该类患者对手术治疗的选择奋更高的风 险，尤其当合并有血小板减少症、凝血功能障碍、腹水、严重肝功能受损、多脏 器功能衰揭(multiple organ failure,MOF)时往往失去