Hayakumo T, Nakajima M, Yasuda K, Cho E, Mukai H, Mizuma Y, Ashihara T, Mizuno S, Hirano S, Ikeda E
Department of Gastroenterology, Kyoto Second Red Cross Hospital.
Nihon Shokakibyo Gakkai Zasshi. 1991 Sep;88(9):2119-26.
We performed percutaneous transhepatic gallbladder drainage (PTGBD) in 71 of 129 patients with acute cholecystitis. In 70 of 71 patients, clinical symptoms and laboratory data were rapidly improved by PTGBD. In order to evaluate the degree of acute cholecystitis, the clinical symptoms, laboratory data and ultrasonographic findings of these patients were analyzed by the quantification theory of Hayashi. As a result, irregular thickening of the gallbladder wall and gallbladder swelling presented by US and physical findings with Blumberg's sing or defence in the abdomen were most important findings to assess the severity of acute cholecystitis. Based on these data, we originally introduced the Severity Score of this disease and used it a criterion of PTGBD indication. The patients with the score above 0.5 were considered to be indicative for emergent PTGBD. In high risk patients (e.g., the aged or of diabetes mellitus) with the score above 0, this procedure should be indicated. In 24 of 71 patients, Percutaneous Transhepatic Gallbladder Scope (PTGBS) were attempted to retrieve stones, and it was completely successful in 16 patients.
我们对129例急性胆囊炎患者中的71例进行了经皮经肝胆囊引流术（PTGBD）。在71例患者中的70例中，PTGBD使临床症状和实验室数据迅速改善。为了评估急性胆囊炎的程度，我们采用林氏量化理论对这些患者的临床症状、实验室数据和超声检查结果进行了分析。结果显示，超声检查发现的胆囊壁不规则增厚和胆囊肿大，以及腹部触诊时出现的墨菲氏征或防御反应，是评估急性胆囊炎严重程度的最重要发现。基于这些数据，我们首次引入了本病的严重程度评分，并将其作为PTGBD适应证的标准。评分高于0.5的患者被认为适合紧急PTGBD。评分高于0的高危患者（如老年人或糖尿病患者）也应进行该手术。在71例患者中的24例中，尝试通过经皮经肝胆囊镜检查（PTGBS）取石，16例患者完全成功。
