热带病与寄生虫学

热带病与寄生虫学 ›› 2022, Vol. 20 ›› Issue (5): 270-273.

• 临床研究 • 上一篇    下一篇

经腹腔胆囊穿刺引流术在晚期血吸虫病患者急性胆囊炎治疗中的应用

刘敏，翟大明，汤卫忠，赵奕文   

  1. 上海市奉贤区中心医院超声医学科，上海 201499
  • 收稿日期:2022-03-23 出版日期:2022-10-20 发布日期:2022-11-16
  • 作者简介:刘敏，男，本科，主治医师，研究方向：介入超声。E-mail：35452414@qq.com

Application of abdominal percutaneous cholecystostomy in acute cholecystitis in patients with advanced schistosomiasis hepatica

LIU Min, ZHAI Da-ming, TANG Wei-zhong, ZHAO Yi-wen   

  1. Department of Ultrasound Medicine, Fengxian District Central Hospital, Shanghai 201499, China
  • Received:2022-03-23 Online:2022-10-20 Published:2022-11-16

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摘要： 目的 探讨经腹腔胆囊穿刺引流术（percutaneous cholecystostomy, PC）在晚期血吸虫病患者急性胆囊炎治疗中的应用价值。方法 分析2016年1月—2021年1月在上海市奉贤区中心医院行经腹腔PC的17例晚期血吸虫病合并急性胆囊炎患者临床资料，记录置管操作时间、临床症状缓解时间、保留置管时间，对比分析术前及术后72 h血清相关炎症和肝功能指标。结果 所有穿刺置管均一次性成功，置管操作时间（14.1±4.3） min，临床症状缓解时间（54.2±9.8） h，保留置管时间（19.0±5.4） d。术前血清白细胞计数、中性粒细胞百分比、超敏C反应蛋白、降钙素原、白细胞介素-6分别为20.6（18.2，23.7）×109 /L、（81.2±12.4）%、（140±15） mg/L、（0.46±0.13） ng/mL、（176±25） pg/mL；术后72 h上述血清相关炎症指标分别为13.2（11.5，16.6）×109 /L、（69.9±15.8）%、（81±14） mg/L、（0.34±0.12） ng/mL、（135±25） pg/mL，与术前相比，差异均有统计学意义（Z =-3.962，t =2.261、14.259、3.592、6.432，P均<0.05）。术前丙氨酸氨基转移酶、γ-谷氨酰转肽酶、门冬氨酸氨基转移酶、血清总胆红素、血清总蛋白分别为52.0（30.0，85.5） U/L、62.5（40.0，83.3） U/L、43.0（21.0，59.0） U/L、19.9（15.5，30.4） μmol/L、（54.0±9.7） g/L；术后72 h上述肝功能主要相关指标分别为51.0（28.3，80.5） U/L、58.0（38.5，84.5） U/L、41.9（19.5，50.0） U/L、16.1（14.7，25.7） μmol/L、（68.4±10.3） g/L，与术前相比，血清总胆红素、血清总蛋白差异有统计学意义（Z =-2.150，t =3.603，P均<0.05）。结论 晚期血吸虫病合并急性胆囊炎患者采用经腹腔PC治疗安全有效，对患者后期治疗有积极的影响。

关键词: 胆囊穿刺引流术, 晚期血吸虫病, 急性胆囊炎, 治疗

Abstract: Objective  To assess the value of percutaneous cholecystectomy (PC) in the treatment of acute cholecystitis in patients with advanced schistosomiasis. Methods  The clinical data, including the time consumed in intubation, the time of clinical symptom remission and catheter retained, were collected and analyzed in 17 patients with advanced schistosomiasis complicated with acute cholecystitis treated in our hospital between January 2016 and January 2021. The serum related inflammation and liver function indexes before and 72 hours after the operation were compared and analyzed. Results  Puncture and catheterization was successful at one time. Catheterization consumed (14.1±4.3) min. Remission of the clinical symptom was (54.2±9.8) h, and the catheter was retained for (19.0±5.4) d. Preoperative serum inflammatory indicators, including leukocyte count, percentage of neutrophil, high-sensitivity C-reactive protein, procalcitonin and interleukin-6 were 20.6 (18.2，23.7)×109 /L, (81.2±12.4)%, (140±15) mg/L, (0.46±0.13) ng/mL and (176±25) pg/mL, respectively. The above serum related inflammatory indicators were 13.2(11.5，16.6)×109/L, (69.9 ± 15.8)%, (81±14) mg/L, (0.34 ± 0.12) ng/mL and (135 ± 25) pg/mL, respectively, at 72 h after operation. The difference was significant compared to those before operation (Z =-3.962; t =2.261, 14.259, 3.592, 6.432, respectively, all P<0.05). Major preoperative liver function related indicators, including alanine aminotransferase γ-glutamyltranspeptidase, aspartate aminotransferase, serum total bilirubin, and serum total protein were 52.0 (30.0, 85.5) U/L, 62.5 (40.0, 83.3) U/L, 43.0 (21.0, 59.0) U/L, 19.9 (15.5, 30.4) μmol/L and (54.0 ± 9.7) g/L, respectively. At 72 h after operation, the main indexes related to liver function were 51.0 (28.3, 80.5) U/L, 58.0 (38.5, 84.5) U/L, 41.9 (19.5, 50.0) U/L, 16.1 (14.7, 25.7) μmol/L, and (68.4 ± 10.3) g/L, respectively. Compared with those before operation, the differences in serum total bilirubin and serum total protein were statistically significant (Z =-2.150; t =3.603, all P<0.05). Conclusion  The intraperitoneal PC is safe and effective for patients with advanced schistosomiasis complicated with acute cholecystitis, and has a positive impact on the late treatment of such patients.

Key words: Percutaneous cholecystectomy, Advanced schistosomiasis；Acute cholecystitis；Treatment

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