- 期刊
經皮穿肝膽囊引流術於急性膽囊炎治療之臨床效益
The Clinical Benefits of PTGBD on Therapy of Acute Cholecystitis
摘要
急性膽囊炎是一種好發於年長者之腹部急性病。早期之治療方式除了內科保守治療外，剖腹摘取膽囊是首選方式。自1980年代腹腔鏡手術技術發展，已逐漸成為標準治療方式。但對於年長、嚴重疾病、或合併其他嚴重慢性疾病病人，需考慮手術之併發症率及成功率。本文目的為文獻回顧探討經皮穿肝膽囊引流術（PTGBD, percutaneous transhepatic gallbladder drainage）於急性膽囊炎治療之臨床效益，並以一代表性病例討論之。我們回顧多年來相關國內與國外之研究報告，加以整理、分別討論急性膽囊炎臨床特性，診斷發展與經皮穿肝膽囊引流術於急性膽囊炎之臨床治療效益。急性膽囊炎典型症狀有急性右上腹疼痛、發燒、伴隨噁心等。一般於臨床診斷除前述症狀外，亦配合超音波、電腦斷層、與血液生化檢查確診。經皮穿肝膽囊引流術於臨床應用之價值在於提供手術之外另一種治療選擇。許多急性膽囊炎病人因嚴重、年長或合併其他如腦血管疾病、心血管疾病與嚴重代謝疾病等慢性病，無法接受麻醉或手術風險過高，而經皮穿肝膽囊引流扮演除了如抗生素注射等保守性治療之外重要的處置角色。經皮穿肝膽囊引流術為一項低併發症、安全且可於床邊實行之介入性技術，並可有效緩解病人因膽囊炎引起的腹痛不適，阻止病程往膽囊穿孔、壞疽與腹膜感染而敗血發展。其次，提供無法接受麻醉手術之年長、合併嚴重慢性疾病病人另外之有效治療方式，並可降低日後若接受手術之併發症風險。
並列摘要
Acute cholecystitis is a kind of common abdominal disease, that incidence increases with age. In early era, except conservative therapy, open cholecystectomy is main strategy. Since laparoscopic cholecystectomy has been developed in 1980s, that became the main stream. However, the complication rate of severe, elderly and comorbidity patients after cholecystectomy should be taken into a account. Our purpose is to confer the clinical benefits of PTGBD (percutaneous transhepatic gallbladder drainage) on therapy of acute cholecystitis by paper reviewing and raising case .We reviewed a lot years latest published articles to summarize this issue, and discuss the clinical benefits of PTGBD on therapy of acute cholecystitis.The typical symptoms of acute cholecystitis are RUQ pain, fever and nausea. The diagnosing according the symptoms, medical imagingand blood routine examination. The value of PTGBD is to provide another alternative. The patients who are severe, elderly or comorbidity disease not fit the condition of operative or anesthesia. PTGBD is an invasion procedure and that possess the characteristic of lower complication rate, safe and easy carrying out bed side. That could remission uncomfortable on RUQ effectively and stops processing of gallbladder perforation, gangrene and peritonitis. Additionally, it could provide another alternative for unsuitable operative or anesthesia patients, and decrease the complication risk of delay cholecystectomy.