经皮经肝胆囊穿刺术治疗老年急性胆囊炎的研究进展
Progress of Percutaneous Transhepatic Cholecystectomy in the Treatment of Acute Cholecystitis in Elderly People
DOI: 10.12677/acm.2024.1492499, PDF,   
作者: 李逸阳, 戴力华, 龚 韩, 杨 超：吉首大学医学院，湖南 吉首；宋 新*：吉首大学第一附属医院肝胆一科，湖南 吉首；张 帆：吉首大学第一附属医院乳甲外科，湖南 吉首
关键词: 急性胆囊炎；老年患者；危重症；经皮经肝胆囊穿刺置管引流术；Acute Cholecystitis； Elderly Patients； Critical Care； Percutaneous Transhepatic Gallbladder Puncture Placement and Drainage
摘要: 急性胆囊炎是常见的急腹症之一。近年来，随着微创技术的进步和外科医师腹腔镜水平的提升，腹腔镜下胆囊切除术已成为治疗急性胆囊炎的金标准，因其创伤小、操作简单、术后恢复快而备受推崇。但对于高龄、合并严重基础疾病的高危患者而言，急诊行LC存在着较高的手术风险。超声引导下经皮经肝胆囊穿刺引流术能够有效减轻胆囊压力、迅速缓解感染症状，目前已逐渐成为有手术禁忌的患者首选的治疗措施。本文对PTGBD的现状和问题进行综述，并对其未来前景进行讨论。
Abstract: Acute cholecystitis is one of the common acute abdominal diseases. In recent years, with the advancement of minimally invasive technology and the improvement of surgeons’ laparoscopic level, laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis, which is highly respected because of its small trauma, simple operation, and fast postoperative recovery. However, for high-risk patients of advanced age and combined with severe underlying diseases, there is a high surgical risk of performing LC in emergency. Ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage (PTGBD) can effectively reduce gallbladder pressure and rapidly alleviate the symptoms of infection, and has gradually become the preferred therapeutic measure for patients with contraindications to surgery. This article reviews the current status and problems of PTGBD and discusses its future prospects.
文章引用：李逸阳, 戴力华, 龚韩, 宋新, 张帆, 杨超. 经皮经肝胆囊穿刺术治疗老年急性胆囊炎的研究进展[J]. 临床医学进展, 2024, 14(9): 561-566. https://doi.org/10.12677/acm.2024.1492499

参考文献

[1] Kimura, Y., Takada, T., Strasberg, S.M., Pitt, H.A., Gouma, D.J., Garden, O.J., et al. (2013) TG13 Current Terminology, Etiology, and Epidemiology of Acute Cholangitis and Cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences, 20, 8-23. [Google Scholar] [CrossRef] [PubMed]
[2] 卢绮萍. 慎重对待胆囊良性疾病的外科诊治问题[J]. 中华外科杂志, 2021, 59(4): 255-259.
[3] 殷强, 胡勇军, 晏华军, 等. 经皮经肝胆囊穿刺置管引流术治疗老年急性胆囊炎的疗效分析[J]. 中国普外基础与临床杂志, 2017, 24(12): 1521-1523.
[4] 张宇航, 马艳波, 杜青. 经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性胆囊炎手术时机的选择[J]. 中华普通外科杂志, 2018, 33(5): 366-368.
[5] Hung, Y., Sung, C., Fu, C., Liao, C., Wang, S., Hsu, J., et al. (2021) Management of Patients with Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Frontiers in Surgery, 8, Article 616320. [Google Scholar] [CrossRef] [PubMed]
[6] Doi, S., Yasuda, I., Mabuchi, M., Iwata, K., Ando, N., Iwashita, T., et al. (2018) Hybrid Procedure Combining Endoscopic Gallbladder Lavage and Internal Drainage with Elective Cholecystectomy for Acute Cholecystitis: A Prospective Pilot Study (the Blade Study). Digestive Endoscopy, 30, 501-507. [Google Scholar] [CrossRef] [PubMed]
[7] Kiviniemi, H., Mäkelä, J.T., Autio, R., et al. (1998) Percutaneous Cholecystostomy in Acute Cholecystitis in High-Risk Patients: An Analysis of 69 Patients. International Surgery, 83, 299-302.
[8] Sugiyama, M., Tokuhara, M. and Atomi, Y. (1998) Is Percutaneous Cholecystostomy the Optimal Treatment for Acute Cholecystitis in the Very Elderly? World Journal of Surgery, 22, 459-463. [Google Scholar] [CrossRef] [PubMed]
[9] Chopra, S., Dodd, G.D., Mumbower, A.L., Chintapalli, K.N., Schwesinger, W.H., Sirinek, K.R., et al. (2001) Treatment of Acute Cholecystitis in Non-Critically Ill Patients at High Surgical Risk: Comparison of Clinical Outcomes after Gallbladder Aspiration and after Percutaneous Cholecys-Tostoym. American Journal of Roentgenology, 176, 1025-1031. [Google Scholar] [CrossRef] [PubMed]
[10] Akhan, O., Akıncı, D. and Özmen, M.N. (2002) Percutaneous Cholecystostomy. European Journal of Radiology, 43, 229-236. [Google Scholar] [CrossRef] [PubMed]
[11] Donald, J.J., Cheslyn-Curtis, S., Gillams, A.R., Russell, R.C. and Lees, W.R. (1994) Percutaneous Cholecystolithotomy: Is Gall Stone Recurrence Inevitable? Gut, 35, 692-695. [Google Scholar] [CrossRef] [PubMed]
[12] Hultman, C.S., Herbst, C.A., Mccall, J.M., et al. (1996) The Efficacy of Percutaneous Cholecystostomy in Critically Ill Patients. The American Surgeon, 62, 263-269.
[13] Melin, M.M., Sarr, M.G., Bender, C.E. and van Heerden, J.A. (1995) Percutaneous Cholecystostomy: A Valuable Technique in High-Risk Patients with Presumed Acute Cholecystitis. British Journal of Surgery, 82, 1274-1277. [Google Scholar] [CrossRef] [PubMed]
[14] Davis, C.A. (1999) Effective Use of Percutaneous Cholecystostomy in High-Risk Surgical Patients: Techniques, Tube Management, and Results. Archives of Surgery, 134, 727-731. [Google Scholar] [CrossRef] [PubMed]
[15] Gallaher, J.R. and Charles, A. (2022) Acute Cholecystitis: A Review. JAMA, 327, 965-975. [Google Scholar] [CrossRef] [PubMed]
[16] Lillemoe, K.D. (2000) Surgical Treatment of Biliary Tract Infections. The American Surgeon, 66, 138-144. [Google Scholar] [CrossRef] 
[17] Tsuyuguchi, T., Itoi, T., Takada, T., Strasberg, S.M., Pitt, H.A., Kim, M., et al. (2013) TG13 Indications and Techniques for Gallbladder Drainage in Acute Cholecystitis (with Videos). Journal of Hepato-Biliary-Pancreatic Sciences, 20, 81-88. [Google Scholar] [CrossRef] [PubMed]
[18] Mori, Y., Itoi, T., Baron, T.H., Takada, T., Strasberg, S.M., Pitt, H.A., et al. (2017) Tokyo Guidelines 2018: Management Strategies for Gallbladder Drainage in Patients with Acute Cholecystitis (with Videos). Journal of Hepato-Biliary-Pancreatic Sciences, 25, 87-95. [Google Scholar] [CrossRef] [PubMed]
[19] 石卉, 万军, 徐世平, 等. 老年胆系感染患者临床特征分析及死亡风险评估[J]. 中华内科杂志, 2019, 58(6): 415-418.
[20] 郭荣利, 黄崑, 梁松年, 等. 超声引导经皮胆囊穿刺引流治疗急性重症胆囊炎12例分析[J]. 中国实用外科杂志, 2011, 31(11): 1045, 1047.
[21] 孙向东, 周艳丽, 王广军, 等. 经皮经肝胆囊穿刺引流术联合LC治疗高危老年急性胆囊炎[J]. 中国医师杂志, 2015(3): 443-444.
[22] 刘亮, 高立兵, 顾建平, 等. 经皮经肝胆囊穿刺置管引流术治疗急性化脓性胆囊炎21例[J]. 介入放射学杂志, 2020, 29(11): 1151-1153.
[23] 张崇, 沈思思, 王明辉, 等. 直接行腹腔镜胆囊切除术与联合经皮经肝胆囊穿刺引流治疗急性重症胆囊炎的荟萃分析[J]. 中华肝胆外科杂志, 2019, 25(12): 910-914.
[24] Tan, H., Jiang, D., Li, J., He, K. and Yang, K. (2018) Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials. Journal of Laparoendoscopic & Advanced Surgical Techniques, 28, 248-255. [Google Scholar] [CrossRef] [PubMed]
[25] Wang, C., Chou, H., Liu, K., Lien, W., Wang, H. and Wu, Y. (2013) Long‐Term Outcome of Patients with Acute Cholecystitis Receiving Antibiotic Treatment: A Retrospective Cohort Study. World Journal of Surgery, 38, 347-354. [Google Scholar] [CrossRef] [PubMed]
[26] Melloul, E., Denys, A., Demartines, N., Calmes, J.‐. and Schäfer, M. (2011) Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does It Matter? World Journal of Surgery, 35, 826-833. [Google Scholar] [CrossRef] [PubMed]
[27] Jin, X., Jiang, Y. and Tang, J. (2022) Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Improves the Prognosis of Patients with Severe Acute Cholecystitis. Evidence-Based Complementary and Alternative Medicine, 2022, Article ID: 5045869. [Google Scholar] [CrossRef] [PubMed]
[28] Hung, Y., Chong, S., Cheng, C., Liao, C., Fu, C., Hsieh, C., et al. (2020) Natural Course of Acute Cholecystitis in Patients Treated with Percutaneous Transhepatic Gallbladder Drainage without Elective Cholecystectomy. Journal of Gastrointestinal Surgery, 24, 772-779. [Google Scholar] [CrossRef] [PubMed]
[29] Tomimaru, Y., Fukuchi, N., Yokoyama, S., Mori, T., Tanemura, M., Sakai, K., et al. (2022) Effect of Preserving the Percutaneous Gallbladder Drainage Tube before Laparoscopic Cholecystectomy on Surgical Outcome: Post Hoc Analysis of the CSGO-HBP-017. Journal of Gastrointestinal Surgery, 26, 1224-1232. [Google Scholar] [CrossRef] [PubMed]
[30] 张宇华. 急性胆道感染《东京指南(2018)》拔萃[J/OL]. 中国实用外科杂志, 2018, 38(7): 767-774.
[31] Lee, S.J., Choi, I.S., Moon, J.I., Yoon, D.S., Lee, S.E., Sung, N.S., et al. (2021) Elective Laparoscopic Cholecystectomy Is Better than Conservative Treatment in Elderly Patients with Acute Cholecystitis after Percutaneous Transhepatic Gallbladder Drainage. Journal of Gastrointestinal Surgery, 25, 3170-3177. [Google Scholar] [CrossRef] [PubMed]
[32] Bao, J., Wang, J., Shang, H., Hao, C., Liu, J., Zhang, D., et al. (2021) The Choice of Operation Timing of Laparoscopic Cholecystectomy (LC) after Percutaneous Transhepatic Gallbladder Drainage (PTGBD) for Acute Cholecystitis: A Retrospective Clinical Analysis. Annals of Palliative Medicine, 10, 9096-9104. [Google Scholar] [CrossRef] [PubMed]
[33] Lee, J.S., Lee, S.J., Choi, I.S. and Moon, J.I. (2022) Optimal Timing of Percutaneous Transhepatic Gallbladder Drainage and Subsequent Laparoscopic Cholecystectomy According to the Severity of Acute Cholecystitis. Annals of Hepato-Biliary-Pancreatic Surgery, 26, 159-167. [Google Scholar] [CrossRef] [PubMed]
[34] 何磊. 老年急性结石性胆囊炎经皮经肝胆囊穿刺引流后延期腹腔镜胆囊切除术临床研究[J]. 河南外科学杂志, 2023, 29(6): 98-101.
[35] 李小红, 张孔玺, 李越洲, 等. 老年急性胆囊炎经皮经肝胆囊穿刺引流术后最佳手术时机的Meta分析[J]. 腹腔镜外科杂志, 2023, 28(2): 123-132.

为你推荐