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經皮膽囊造瘻術之臨床應用
Clinical Applications of Percutaneous Cholecystostomy
摘要
台中榮民總醫院近四年來，共有16位病患接受經皮膽囊造瘻術，其中13例是急性膽囊炎，另外3例是末段總膽管阻塞造成的黃疸；在13例急性膽囊炎病患中，膽結石性者有9例，非膽結石性者有4例，均合併有高手術危險性或有廣泛之癌症蔓延而不適合手術者；另3例末段總膽管阻塞之病例中，有一例因病情不穩呈昏迷狀態，一例合併有膽管炎而另一例因肝內膽管僅輕度擴大使施行經皮穿肝膽道引流術困難，而採用膽囊造瘻術引流膽汁；所有病例都在超音波及放射線透視儀器的引導下由右前外側之肋間穿過肝臟施行。急性膽囊炎之病例除一例因原來已產生無法控制之敗血病而仍然在膽囊引流後次日死亡外，其餘病患在接受膽囊引流後均渡過急性發炎期，而後有6位膽結石之病患成功地接受膽囊切除術，其餘6位病患經膽囊引流後並未切除膽囊但也未再發生急性膽囊炎。3例末段總膽管阻塞的病患在接受膽囊造瘻術引流膽汁後黃疸指數均呈明顯下降。所有病例中均無併發症發生。因此，在超音波及放射線透視儀器的引導下，經皮穿肝膽囊造瘻術是一安全而且容易施行的治療方法，可以幫助手術危險性高的急性膽囊炎病患渡過急性期，而對於末段總膽管阻塞造成黃疸的病患，經皮膽囊造瘻術也是經皮穿肝膽道引流術外的另一種引流膽汁、降低黃疸的方法。
並列摘要
Percutaneous cholecystostomy was performed for 16 patients in Taichung Veterans General Hospital during the past 4 years, which included 13 cases of acute cholecystitis and 3 cases of obstructive jaundice on account of distal CBD obstruction. In the 13 patients who suffered from acute cholecystitis, 9 were of calculous cholecystitis and the other 4 of acalculous cholecystitis. They were associated with either high surgical risk or disseminated malignancy in the abdomen. Three patients with obstructive jaundice received percutaneous cholecystostomy due to the high risk and difficulty in performing PTBD. All the procedures were performed under ultrasound and fluoroscopic guidance and via transhepatic route. All except one case with acute cholecystitis had satisfactory result to control cholecystitis after gallbladder drainage and 6 cases with calculous cholecystitis subsequently received cholecystectomy. Only one patient died of uncontrollable sepsis despite successful performance of percutaneous cholecystostomy. For the 3 patients with obstructive jaundice, the bilirubin level decreased significantly after the procedure. No complication was encountered in this series. It is clear that under ultrasound and fluoroscopic guidance, percutaneous cholecystostomy is an effective life-saving procedure for acute cholecystitis especially for the candidates at high surgical risk. This procedure is also an alternative to relieve jaundice caused by distal CBD obstruction if PTBD is infeasible.
延伸閱讀
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