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目的探讨序贯微创治疗对伴重要器官功能障碍的老年急性结石性胆囊炎患者的疗效及时机。方法回顾性收集笔者所在医院2012年12月至2013年12月期间笔者所在医院科室收治的67例老年急性结石性胆囊炎且伴重要脏器功能障碍患者的临床资料。67例患者先在B超或CT引导下行经皮经肝胆囊穿刺引流术(PTGBD),同时给予全身抗感染治疗,待全身情况好转后再序贯性择期行腹腔镜胆囊切除术(LC)。结果 67例患者均成功完成PTGBD,穿刺成功率为100%;有65例完成PTGBD及其后续检查,与PTGBD前比较,治疗后第1天和第4天患者的腹痛、腹胀、呕吐、白细胞计数、中性粒细胞比值、谷丙转氨酶(GPT)水平、总胆红素(T-bil)水平及C反应蛋白(CRP)水平及体温均明显好转(P<0.05)。PTGBD后有3例因症状缓解后不考虑手术而拔出引流管,2例中转为开腹小切口胆囊切除术,余60例成功实施了LC。所有患者均于术后2~7 d痊愈出院。结论对伴重要器官功能障碍的老年急性结石性胆囊炎患者,序贯微创治疗具有安全、简便、有效、创伤小及患者恢复快的优点。
Objective To investigate the efficacy and timing of sequential minimally invasive treatment of senile patients with acute calcific cholecystitis associated with major organ dysfunction. Methods Retrospectively collected the clinical data of 67 elderly patients with acute cholecystitis of cholecystitis complicated with major organ dysfunction who were admitted to our hospital from December 2012 to December 2013 in our hospital. Sixty-seven patients underwent percutaneous transhepatic gallbladder drainage (PTGBD) guided by B-ultrasound or CT, and systemic anti-infective therapy was given. After systemic conditions improved, they underwent laparoscopic cholecystectomy (LC). Results All of the 67 patients completed PTGBD successfully and the puncture success rate was 100%. There were 65 cases completed PTGBD and its follow-up examination. Compared with the pre-PTGBD, the patients had abdominal pain, bloating, vomiting, white blood cell count , Neutrophil ratio, GPT level, total bilirubin (T-bil) level and C-reactive protein (CRP) level and body temperature were significantly improved (P <0.05). After PTGBD, there were 3 cases of drainage tube removed without consideration of surgery after surgery and 2 cases of small incision cholecystectomy. The remaining 60 cases were successfully performed LC. All patients were discharged after 2 ~ 7 days. Conclusion Sequential minimally invasive treatment of elderly patients with acute calculous cholecystitis with organ dysfunction is safe, simple and effective, with less trauma and faster recovery of patients.