Sheridan R L, Ryan C M, Lee M J, Mueller P R, Tompkins R G
Shriners Burns Institute, Boston, MA 02114.
J Trauma. 1995 Feb;38(2):248-51. doi: 10.1097/00005373-199502000-00019.
We desired to demonstrate the utility of percutaneous cholecystostomy in the evaluation and management of critically ill burn patients with fever and rising cholestatic chemistries.
Retrospective review.
Over a 2 1/2-year period there were 411 admissions to a regional adult burn until of whom six patients (1.5%) were strongly suspected of having developed acute cholecystitis. Five were managed with percutaneous cholecystostomy.
All patients had sonographic signs consistent with acute cholecystitis. One was managed with immediate laparotomy and the remaining five patients underwent ultrasound-guided percutaneous transhepatic cholecystostomy at the bedside (n = 4) or in the ultrasonography suite (n = 1) without complication. One patient died of multiple organ failure 3 days after catheter placement despite good catheter position and function. Two of the surviving patients responded promptly to drainage of the gallbladder with resolution of fever and normalization of liver function tests. Two patients did not respond despite catheters that were properly placed and functioning, reliably eliminating the diagnosis of acute cholecystitis. One patient underwent interval cholecystectomy after wound closure and the remaining patients were discharged after catheters were removed.
Bedside percutaneous cholecystostomy is a minimally invasive procedure that can facilitate the evaluation and management of the critically ill burn patient with fever and rising cholestatic chemistries in whom a diagnosis of acute cholecystitis is suspected.
我们希望证明经皮胆囊造瘘术在评估和治疗伴有发热及胆汁淤积化学指标升高的重症烧伤患者中的作用。
回顾性研究。
在2年半的时间里，一家地区性成人烧伤中心共收治411例患者，其中6例（1.5%）被高度怀疑发生了急性胆囊炎。5例接受了经皮胆囊造瘘术治疗。
所有患者均有与急性胆囊炎相符的超声征象。1例接受了急诊剖腹手术，其余5例患者在床边（n = 4）或超声检查室（n = 1）接受了超声引导下经皮经肝胆囊造瘘术，均无并发症发生。1例患者在置管后3天死于多器官功能衰竭，尽管导管位置及功能良好。2例存活患者在胆囊引流后发热消退，肝功能检查恢复正常。2例患者尽管导管放置正确且功能良好，但病情无改善，从而可靠地排除了急性胆囊炎的诊断。1例患者在伤口愈合后接受了择期胆囊切除术，其余患者在拔除导管后出院。
床边经皮胆囊造瘘术是一种微创手术，可有助于对怀疑患有急性胆囊炎、伴有发热及胆汁淤积化学指标升高的重症烧伤患者进行评估和治疗。
