- 期刊
經皮穿肝膽囊引流術以治療急性化膿性膽囊炎
Percutaneous Transhepatic Gallbladder Drainage (PTGBD) for Empyema of Gallbladder
摘要
經皮穿肝膽囊引流術是一種不需要手術，即可提供相當於膽囊造瘻術的技術，在局部麻醉下很快地把感染的膽汗引流體外，令臨床症狀得以快速改善；由於此技術的安全簡便及侵襲性小，對於需要緊急進行膽囊造瘻術的年老病人或高手術危機者，有著極大的裨益。 我們在超音波的誘導下，經由肝臟膽囊床進行膽囊穿刺引流，共經驗8個病例，其平均年齡為62.5±10.8歲，三分之二的病例有嚴重的合併疾病，其中4例為無石急性膽囊炎，另4例有膽囊結石，其中1例合併有總膽管結石；所有病例都有發燒，右上腹痛，陽性Murphy's sigh及白血球增多，2例有黃疸。經膽囊引流之後平均於1.63日內退熱，腹痛平均也於1.41日消褪，引流至手術日期平均為8.5日，所有病人的平均住院日數為16.5日。 膽囊炎的超音波所見為，膽囊腫大平均為9.8×5.2cm，膽囊壁肥厚平均為6.4mm，並可見到膽囊內有泥狀物；抽出的膽汁呈現混濁或濃樣，暗綠色或暗褐色或黃白色；膽汁細菌培養率為87.5%，培出菌以大腸菌為最多。 沒有死亡的病例，也沒有併發症發生。
並列摘要
Percutaneous transhepagtic drainage of gallbladder (PTGBD) was a safe and simple technique, it drained infected bile equally as surgical cholecystostomy; and it was of benefit to aged or patient of high surgical risk. There were 8 cases, cholecystitis with gallbladder stone 4, acalculous cholecystitis 4 undergoing PTGBD in this hospital from July 1984 until July 1985. The average age of patients was 62.5±10.8. Two thirds of patients suffered from severe concomitant diseases. All patients are present with fever, right upper quadrant pain, positive Murphy's sign with leukocyotosis. Two cases were iteric. The fever subsided at an average of 1.63 days after drainage, abdominal pain was 1.41 days and the average admission days was 16.5. The period from drainage to operation was 8.5 days. All the gallbladders were distended and enlarged, ave. 9.8×5.2cm, also the wall was thickened ave. 6.4mm. The drained bile was infected and the bile was cultured, which grew E. coli most commonly. The positive rate of bile culture was 87.5%. There was no mortality, also no complication.