經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)在膽囊炎急性發(fā)作治療中的應(yīng)用現(xiàn)狀

史洪石，靳君華 綜述 趙海平 審校

（內(nèi)蒙古醫(yī)科大學(xué)附屬醫(yī)院 肝膽外科，內(nèi)蒙古 呼和浩特 010000）

經(jīng)皮經(jīng)肝膽囊穿刺引流（percutaneous transhepatic gallbladder puncture and drainage，PTGBD）首次由Burckhardt在1921年做出報(bào)告[1]。在1980年，經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)方才應(yīng)用于臨床實(shí)踐[2-4]。直到19世紀(jì)80年代，介入科醫(yī)師對(duì)這項(xiàng)技術(shù)更為熟練成熟，并發(fā)表了第1個(gè)病例報(bào)告[5]。自此，這項(xiàng)治療措施對(duì)膽囊炎急性發(fā)作，提供了一個(gè)有效的解決方案[6-9]。林曉鐮等[10]在我國(guó)首先對(duì)經(jīng)皮經(jīng)肝膽管造影及引流術(shù)做出報(bào)道，為PTGBD在我國(guó)的發(fā)展創(chuàng)造了良好的前提。王光星等[11]初步探討了超聲從診斷轉(zhuǎn)向治療的體會(huì)，并取得了滿意的臨床答案。但這項(xiàng)技術(shù)一直傾向用于治療梗阻性黃疸的患者，達(dá)到減黃目的，以減少當(dāng)時(shí)由于經(jīng)驗(yàn)不足，而穿刺肝管導(dǎo)致失敗的發(fā)生率。王孝華等[12]對(duì)PTGBD治療膽囊急性發(fā)作的可行性，進(jìn)行臨床試驗(yàn)，并取得滿意得結(jié)果。時(shí)至今日，PTGBD的文獻(xiàn)報(bào)道部分僅限于老年人急性膽囊炎合并臟器功能不全、手術(shù)風(fēng)險(xiǎn)較大或手術(shù)禁忌證者，但是具體適應(yīng)證人群及配合二期手術(shù)膽囊切除術(shù)時(shí)機(jī)方面暫無系統(tǒng)報(bào)道。本文就上述3點(diǎn)做一綜述，以供臨床參考。

1 PTGBD的優(yōu)點(diǎn)

超聲引導(dǎo)下PTGBD能減少急診手術(shù)和麻醉雙重打擊帶來的風(fēng)險(xiǎn)，為患者渡過急性期、爭(zhēng)取擇期手術(shù)提供了寶貴的時(shí)間[13]。超聲靈活，操作方便、無放射性損害，安全性高，僅需要局麻及少量鎮(zhèn)靜處理?；颊叨嘁蚰昀象w弱和病情危重而不宜搬動(dòng)，可在床旁進(jìn)行超聲快速準(zhǔn)確操作，手術(shù)在局麻下進(jìn)行。穿刺時(shí)超聲可精確定位膽囊位置，可在動(dòng)態(tài)下選擇穿刺路徑，操作精準(zhǔn)，成功率較高且手術(shù)并發(fā)癥少[14]。同時(shí)，對(duì)引流出的膽汁行細(xì)菌學(xué)檢查及藥敏培養(yǎng)，可以更好地指導(dǎo)臨床合理用藥，提高治療效果。膽囊急性水腫期膽囊脹大，經(jīng)PTGBD治療，穿刺成功率高，可以迅速減輕膽囊壓力，有效緩解癥狀，使患者免于急性期行手術(shù)，降低了手術(shù)風(fēng)險(xiǎn)，也符合損傷控制外科的理念[15-16]。特別是老年患者，在膽囊炎急性發(fā)作時(shí)，由于急性炎癥期，導(dǎo)致原有基礎(chǔ)疾病瞬時(shí)發(fā)作，若不能及時(shí)處理，易產(chǎn)生嚴(yán)重后果。雖然PTGBD不能取代手術(shù)治療，但該治療方法可迅速減輕患者癥狀，改善患者全身狀態(tài)，是一種非常重要的姑息性治療手段[17]。有研究[18]統(tǒng)計(jì)，技術(shù)成功率為95%～100%，有效率為70%～85%。經(jīng)翔等[19]成功對(duì)753例患者行791次膽道穿刺引流，綜合并發(fā)癥發(fā)生率為17.3%，其中嚴(yán)重并發(fā)癥發(fā)生率僅為1.1%，未出現(xiàn)致死性并發(fā)癥。綜上所述，該項(xiàng)技術(shù)的風(fēng)險(xiǎn)收益比較高，且操作方便，為其后期推廣奠定了基礎(chǔ)。

2 適應(yīng)證

2.1 老年人急性膽囊炎

據(jù)統(tǒng)計(jì)[20],老年急性膽囊炎患者行急診膽囊切除術(shù)的病死率高達(dá)14%～19%，在這種高病死率的情況下，急診手術(shù)則將不再是首要的治療措施。而對(duì)于老年患者，本身不是診斷膽囊炎嚴(yán)重程度的因素[21]，但老年患者應(yīng)激能力較青中年人群低。因此，臨床癥狀常不典型，早期診斷率較低，若出現(xiàn)較為明顯的臨床癥狀，則大多數(shù)已處于疾病惡化階段，而多數(shù)患者伴有高血壓、心臟病、糖尿病等慢性基礎(chǔ)疾病。所以，老年患者膽囊炎急性發(fā)作的手術(shù)風(fēng)險(xiǎn)較高[22-24]。經(jīng)檢索國(guó)內(nèi)外大量文獻(xiàn)，老年患者急性膽囊炎一期行PTGBD術(shù)，均取得了較好的療效。

2.2 急性中、重度膽囊炎

急性膽囊炎嚴(yán)重程度評(píng)估標(biāo)準(zhǔn)首先在全世界TG07[25-27]中提出，其中急性膽囊炎的嚴(yán)重程度分為以下3類：輕度（I級(jí)），中度（II級(jí)）和嚴(yán)重（III級(jí)）。經(jīng)過TG07，TG13賦予急性膽囊嚴(yán)重程度新的診斷標(biāo)準(zhǔn)[21]。其中II級(jí)（中度）急性膽囊炎，與以下條件有關(guān)：⑴ 白細(xì)胞計(jì)數(shù)升高（＞18 000/mm3)；⑵ 右上腹部觸摸腫塊；⑶ 主訴時(shí)間（＞72 h）；⑷ 局限性炎癥（壞疽性膽囊炎，氣腫性膽囊炎等）。若合并凝血、肝腎功損害等嚴(yán)重并發(fā)癥為III級(jí)，而I級(jí)（輕度）急性膽囊炎：不符合“三級(jí)”或“二級(jí)”急性膽囊炎的標(biāo)準(zhǔn)。TG13中明確指出，中、重度的急性膽囊炎不易立即行膽囊切除術(shù)，而PTGBD引流術(shù)既降低了手術(shù)的風(fēng)險(xiǎn)，又能快速解決患者癥狀，為臨床醫(yī)生提供了較為安全的治療方法。

2.3 急性結(jié)石嵌頓性膽囊炎

急性結(jié)石性膽囊炎發(fā)病較急，當(dāng)結(jié)石嵌頓膽囊管突然受阻，膽囊內(nèi)壓力增高，膽囊管黏膜充血、水腫，則導(dǎo)致膽囊壓力進(jìn)一步升高，形成惡性循環(huán)。如果梗阻不能解除，高壓力的膽囊內(nèi)壓，促使膽囊壁出現(xiàn)血運(yùn)障礙，導(dǎo)致膽囊壁發(fā)生穿孔。當(dāng)膽囊內(nèi)已存在感染時(shí)，膽囊極易壞疽，病情迅速惡化[28]。由于膽囊管水腫，與周圍組織粘連嚴(yán)重，導(dǎo)致膽囊管、肝總管及膽總管解剖不清，術(shù)中肝總管或膽總管損傷機(jī)率較大。有研究[29-30]表明,頸部結(jié)石嵌頓是膽道損傷的高危因素，急診行腹腔鏡膽囊切除術(shù)或開腹膽囊切除術(shù)后極易產(chǎn)生如膽漏、膽管炎、膽周積液以及膽囊床滲血等嚴(yán)重并發(fā)癥，嚴(yán)重影響患者的預(yù)后及生活質(zhì)量。

2.4 急性膽囊炎并發(fā)膽總管結(jié)石（結(jié)石直徑＜5 cm）繼發(fā)膽總管結(jié)石可以認(rèn)為是膽囊結(jié)石肝外并

發(fā)癥之一[31]。直徑＜0.5 cm的膽囊結(jié)石較易通過彎曲的膽囊管螺旋瓣，掉落至膽總管。期間，小結(jié)石通過Oddi括約肌，導(dǎo)致其痙攣，患者則出現(xiàn)較為強(qiáng)烈的腹痛，若痙攣長(zhǎng)時(shí)間不能緩解，患者可出現(xiàn)短暫鞏膜輕度黃染，嚴(yán)重時(shí)可誘發(fā)急性胰腺炎?；颊咴诩毙阅懩已装l(fā)作過程中，行超聲或磁共振膽道水成像中，可發(fā)現(xiàn)較小的膽總管結(jié)石，這可以成為膽總管探查的指征[32]。膽管纖細(xì)在急性期探查有暴露膽道困難、增加膽道損傷及術(shù)后膽管狹窄的風(fēng)險(xiǎn)，PTGBD即可緩解急性膽囊炎的癥狀，減輕膽道壓力，又可通過術(shù)后經(jīng)PTGBD管造影確診有無膽管結(jié)石，避免膽道陰性探查，也符合損傷控制外科的理念。

2.5 急性胰腺炎合并急性膽囊炎

目前關(guān)于急性胰腺炎合并急性膽囊炎機(jī)制尚不明確[33-34]?？赡芘c急性胰腺炎時(shí)，機(jī)體出現(xiàn)休克，導(dǎo)致膽囊黏膜缺血，加之患者長(zhǎng)期禁食水，膽囊排空延遲，膽汁淤積等導(dǎo)致膽囊急性炎癥發(fā)生。此外，急性胰腺炎發(fā)作時(shí)可出現(xiàn)胰頭水腫、十二指腸乳頭水腫，膽道壓力增大導(dǎo)致膽汁排出障礙，進(jìn)而導(dǎo)致膽囊炎發(fā)作。急性重癥胰腺炎不易行手術(shù)治療，若合并急性膽囊炎，炎癥進(jìn)一步加重。此時(shí)，行PTGBD術(shù)，為控制損傷的最佳選擇。李剛等[35]觀察571例急性胰腺炎患者。其中合并急性膽囊炎108例，除有明顯禁忌外，76例成功行PTGBD術(shù)。術(shù)后患者各項(xiàng)觀察指標(biāo)，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。綜上所述，急性胰腺炎合并急性膽囊炎時(shí)，行PTGBD術(shù)，可有效減輕炎癥損傷，延緩病情進(jìn)展，為急性胰腺炎合并急性膽囊炎的治療，提供新思路。

3 二期手術(shù)的時(shí)機(jī)

PTGBD雖然可迅速緩解患者的癥狀，且高效、經(jīng)濟(jì)。但PTGBD不能從根本上解除患者病因，因此應(yīng)待其全身狀況好轉(zhuǎn)后行膽囊切除術(shù)，但手術(shù)時(shí)機(jī)目前尚無統(tǒng)一標(biāo)[36-38]。關(guān)于PTGBD術(shù)后行LC時(shí)機(jī)的選擇存在眾多爭(zhēng)議，術(shù)后短時(shí)間內(nèi)行LC術(shù)，膽囊情況無明顯改善，且術(shù)后并發(fā)癥發(fā)生率高，影響患者術(shù)后早期恢復(fù)，不符合目前外科快速康復(fù)理念。有研究[39]顯示，2～4個(gè)月行LC膽囊壁厚度明顯低于2個(gè)月以內(nèi)行LC的患者，表明2個(gè)月內(nèi)患者膽囊壁可能仍處于水腫狀態(tài)，炎癥尚未消退，膽囊及三角的顯露較為困難，從而導(dǎo)致中轉(zhuǎn)為開腹的比例大大增加。因此，若2個(gè)月后，復(fù)查超聲，患者的膽囊壁厚度于較前相比無明顯改變，表明其炎癥已消退，此時(shí)行手術(shù)切除較為容易。PTGBD后行LC的手術(shù)時(shí)機(jī)會(huì)對(duì)患者的恢復(fù)產(chǎn)生重要影響，因此應(yīng)合理評(píng)估患者的基本情況、擇期行LC，以期達(dá)到最好的治療效果[40]。

綜上所述，急性膽囊炎發(fā)病率極高，而急診行腹腔鏡或開腹膽囊切除術(shù)術(shù)中及術(shù)后并發(fā)癥發(fā)生率高。此外，急性膽囊炎為良性病，一旦出現(xiàn)并發(fā)癥不易被家屬接受，這些一直困擾外科醫(yī)生。而PTGBD創(chuàng)傷小、便捷、高效、應(yīng)用廣泛，改善了患者應(yīng)激的狀態(tài)，為二期手術(shù)治療創(chuàng)造了條件。但PTGBD根據(jù)患者的情況，可能置管時(shí)間較長(zhǎng)，影響患者是生活質(zhì)量及外觀，但對(duì)比急性期手術(shù)造成的并發(fā)癥相比，無論是醫(yī)生和患者都可以欣然接受。故今后其應(yīng)用空間廣泛，尤其在基層醫(yī)院將廣受歡迎，但關(guān)于適應(yīng)證及二期手術(shù)時(shí)機(jī)，仍需不斷探索。

[1] 羅成華. 膽囊穿刺造瘺術(shù)治療膽囊結(jié)石的進(jìn)展[J]. 人民軍醫(yī),1991, 34(6):66–67.Luo CH. Progress of gallbladder puncture and cholecystostomy for gallstone[J]. People's Military Surgeon, 1991, 34(6):66–67.

[2] Elyaderani M, Gabriele OF. Percutaneous cholecystostomy and cholangiography in patients with obstructive jaundice[J]. Radiology,1979, 130(3):601–602.

[3] Shaver RW, Hawkins IF, Soong J. Percutaneous cholecystostomy[J].AJR Am J Roentgenol, 1982, 138(6):1133–1136.

[4] Radder RW. Ultrasonically guided percutaneous catheter drainage for gallbladder empyema[J]. Diagn Imaging, 1980, 49(6):330–333.

[5] Baron TH, DeSimio TM. New ex-vivo porcine model for endoscopic ultrasound-guided training in transmural puncture and drainage of pancreatic cysts and fluid collections (with videos)[J].Endosc Ultrasound, 2015, 4(1):34–39. doi: 10.4103/2303–9027.151326.

[6] Hatzidakis AA, Prassopoulos P, Petinarakis I, et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment[J]. Eur Radiol, 2002, 12(7):1778–1784.

[7] Orlov S, Salari F, Kashat L, et al. Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer[J]. Endocrine, 2015,50(1):130–137. doi: 10.1007/s12020–015–0575–0.

[8] Garber SJ, Mathleson JR, Cooperberg PL, et al. Percutaneous cholecystostomy: safety of the transperitoneal route[J]. J Vasc Interv Radiol, 1994, 5(2):295–298.

[9] van Overhagen H, Meyers H, Tilanus HW, et al. Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk[J]. Cardiovasc Intervent Radiol, 1996,19(2):72–76.

[10] 林曉鐮, 馬鈞武, 孫陪立, 等. 超聲引導(dǎo)下經(jīng)皮經(jīng)肝穿刺膽管（或膽囊）置管引流術(shù)[J]. 上海影像學(xué)雜志, 1996, 5(3):132–133.Lin XL, Ma JW, Sun PL, et al. Percutaneous transhepatic biliary(or gallbladder) drainage under ultrasound guidance[J]. Shanghai Journal of Imageology, 1996, 5(3):132–133.

[11] 王光星, 魯煥章, 白月華, 等. 超聲導(dǎo)向膽囊穿刺引流的臨床應(yīng)用體會(huì)[J]. 中國(guó)實(shí)用外科雜志, 1987, 7(4):202.Wang GX, Lu HZ, Bai YH, et al. Application experience of ultrasound-guided gallbladder puncture and drainage[J]. Chinese Journal of Practical Surgery, 1987, 7(4):202.

[12] 王孝華, 蔡中紅, 王長(zhǎng)俊, 等. 膽囊床至肝緣距離的測(cè)量及其與膽囊介入超聲的意義[J]. 中國(guó)超聲醫(yī)學(xué)雜志, 1991, 7(4):264–265.Wang XH, Cai ZH, Wang CJ, et al. Significance of measurement of distance from gallbladder bed to liver edge and gallbladder interventional ultrasound[J]. Journal of Ultrasound in Medicine,1991, 7(4):264–265.

[13] 張振松, 梁曉宇, 何向輝. 經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)治療危重急性膽囊炎患者的臨床療效分析[J]. 中華臨床醫(yī)師雜志:電子版, 2013, 7(6):2493–2496. doi:10.3877/cma.j.issn.1674–0785.2013.06.048.Zhang ZS, Liang XY, He XH. Ultrasound guided PTGBD in critically ill patients with acute cholecystitis [J]. Chinese Journal of Clinicians: Electronic Edition, 2013, 7(6):2493–2496. doi:10.3877/cma.j.issn.1674–0785.2013.06.048.

[14] Liao CY, Tsai CC, Kuo WH, et al. Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature [J]. BMC Nephrol, 2016, 17:23. doi: 10.1186/s12882–016–0237–3.

[15] 李寧. 外科新理念:損傷控制性手術(shù)[J]. 中國(guó)實(shí)用外科雜志, 2007,27(1):28–32.Li N. New surgical concept: damage control surgery[J]. Chinese Journal of Practical Surgery, 2007, 27(1):28–32.

[16] 郁鵬, 詹紹萍, 王錫娟, 等. 超聲引導(dǎo)下穿刺置管治療老年急性膽囊炎65例分析[J]. 人民軍醫(yī), 2016, 59(1):68–69.Yu P, Zhan SP, Wang XJ, et al. Analysis of ultrasound-guided catheterization for acute cholecystitis in elderly patients: a report of 65 cases[J]. People's Military Surgeon, 2016, 59(1):68–69.

[17] 孫青龍, 董重謀, 黃銳, 等. 經(jīng)皮經(jīng)肝穿刺膽囊外引流術(shù)治療重癥急性膽囊炎[J]. 中國(guó)醫(yī)藥科學(xué), 2015, 5(5):155–158.Sun QL, Dong ZM, Huang R, et al. Percutaneous liver puncture gallbladder drainage treatment for severe acute cholecystitis[J].China Medicine and Pharmacy, 2015, 5(5):155–158.

[18] 陳健, 李立波, 胡紅杰, 等. 經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)在高危急性膽囊炎患者中的應(yīng)用[J]. 中華普通外科雜志, 2012, 27(3):239–240. doi:10.3760/cma.j.issn.1007–631X.2012.03.023.Chen J, Li LB, Hu HJ, et al. Application of percutaneous transhepatic gallbladder puncture and drainage in high risk acute cholecystitis[J]. Zhong Hua Pu Tong Wai Ke Za Zhi, 2012,27(3):239–240. doi:10.3760/cma.j.issn.1007–631X.2012.03.023.

[19] 經(jīng)翔, 杜智, 王毅軍, 等. 超聲引導(dǎo)經(jīng)皮經(jīng)肝膽管引流術(shù)并發(fā)癥分析[J]. 中華肝膽外科雜志, 2010, 16(8):600–603. doi:10.3760/cma.j.issn.1007–8118.2010.08.013.Jing X, Du Z, Wang YJ, et al. Analysis of complications after ultrasound-guided PTBD[J]. Chinese Journal of Hepatobiliary Surgery, 2010, 16(8):600–603. doi:10.3760/cma.j.issn.1007–8118.2010.08.013.

[20] 陳占斌, 鄧偉均, 雷曉東. 68例老年急性膽囊炎的手術(shù)治療分析[J]. 中國(guó)普通外科雜志, 2005, 14(8):626–627. doi:10.3969/j.issn.1005–6947.2005.08.022.Chen ZB, Deng WJ, Lei XD. Analysis of surgical treatment of acute cholecystitis in 68 senile patients [J]. Chinese Journal of General Surgery, 2005, 14(8):626–627. doi:10.3969/j.issn.1005–6947.2005.08.022.

[21] Yokoe M, Takada T, Strasberg SM, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)[J]. J Hepatobiliary Pancreat Sci, 2013, 20(1):35–46. doi: 10.1007/s00534–012–0568–9.

[22] 胡志鵬. PTGD聯(lián)合LC治療高原地區(qū)老年急性膽囊炎[J].中國(guó)普通外科雜志, 2014, 23(8):1152–1153. doi:10.7659/j.issn.1005–6947.2014.08.032.Hu ZP. Percutaneous transhepatic gallbladder drainage (PTGD)combined with laparoscopic cholecystectomy for acute cholecystitis in elderly patients in high altitude areas [J]. Chinese Journal of General Surgery, 2014, 23(8):1152–1153. doi:10.7659/j.issn.1005–6947.2014.08.032.

[23] Bruckenthal P, Simpson MH. The role of the perioperative nurse in improving surgical patients'clinical outcomes and satisfaction:beyond medication[J]. AORN J, 2016, 104(6S):S17–22. doi:10.1016/j.aorn.2016.10.013.

[24] 榮萬水, 吳建華, 曾慶敏, 等. 膽囊切除術(shù)與保膽術(shù)治療膽囊結(jié)石的比較[J]. 中國(guó)普通外科雜志, 2011, 20(8):814–817.Rong WS, Wu JH, Zeng QM, et al. Comparison of cholecystectomy and gallbladder-preserving cholecystolithotomy in treatment of gallstones[J].Chinese Journal of General Surgery, 2011, 20(8):814–817.

[25] Yajima H, Kanai H, Son K, et al. Reasons and risk factors for intraoperative conversion from laparoscopic to open cholecystectomy[J].Surg Today, 2014, 44(1):80–83. doi: 10.1007/s00595–012–0465–5.

[26] Shingu Y, Komatsu S, Norimizu S, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis[J]. Surg Endosc, 2016,30(2):526–531. doi: 10.1007/s00464–015–4235–5.

[27] Pang KW, Tan CH, Loh S, et al. Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis[J]. World J Surg, 2016,40(11):2735–2744.

[28] 萬里. 腹腔鏡膽囊切除術(shù)治療急性結(jié)石性膽囊炎中的臨床研究[J]. 中國(guó)普通外科雜志, 2013, 22(6):797–799. doi:10.7659/j.issn.1005–6947.2013.06.030.Wan L. Clinical study of LC in patients with acute calculous cholecystitis [J].Chinese Journal of General Surgery, 2013,22(6):797–799. doi:10.7659/j.issn.1005–6947.2013.06.030.

[29] Kim HO, Ho Son B, Yoo CH, et al. Impact of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute cholecystitis [J]. Surg Laparosc Endosc Percutan Tech, 2009, 19(1):20–24. doi: 10.1097/SLE.0b013e318188e2fe.

[30] Gulaya K, Desai SS, Sato K. Percutaneous Cholecystostomy:Evidence-Based Current Clinical Practice[J]. Semin Intervent Radiol, 2016, 33(4):291–296.

[31] 王中魁, 趙海鷹, 劉金鋼, 等. 老年人膽囊結(jié)石合并膽總管結(jié)石術(shù)式選擇探討[J]. 中國(guó)實(shí)用外科雜志, 2015, 35(4):448–450.Wang ZK, Zhao HY, Liu JG, et al. Comparison of operative methods for older patients with concomitant cholelithiasis and choledocholithiasis: A report of 60 patients [J]. Chinese Journal of Practical Surgery, 2015, 35(4):448–450.

[32] 張淼, 談?dòng)里w. 腹腔鏡下經(jīng)膽囊管膽總管探查術(shù)與膽總管探查并一期縫合術(shù)治療膽總管結(jié)石的對(duì)比研究[J]. 中國(guó)普通外科雜志,2017, 26(2):151–156. doi:10.3978/j.issn.1005–6947.2017.02.004.Zhang M, Tan YF. Comparison of laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration with primary suture for common bile duct stones[J].Chinese Journal of General Surgery, 2017, 26(2):151–156.doi:10.3978/j.issn.1005–6947.2017.02.004.

[33] Majdoub A, Bahloul M, Ouaz M, et al. Severe acute biliary pancreatitis requiring Intensive Care Unit admission: Evaluation of severity score for the prediction of morbidity and mortality[J]. Int J Crit Illn Inj Sci, 2016, 6(3): 155–156.

[34] Kamal A, Sinha A, Hutfless SM, et al. Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis[J].HPB (Oxford), 2017, 19(1):21–28. doi: 10.1016/j.hpb.2016.10.013.

[35] 李剛, 童智慧, 鄒磊, 等. 超聲引導(dǎo)下經(jīng)皮經(jīng)肝膽囊引流治療急性胰腺炎合并急性膽囊炎51例分析[J]. 中國(guó)實(shí)用外科雜志, 2013,33(2):140–142.Li G, Tong ZH, Zou L, et al. Percutaneous transhepatic gallbladder drainage to treat acute pancreatitis complicated with acute cholecystitis guided by ultrasound: a report of 51 cases[J]. Chinese Journal of Practical Surgery, 2013, 33(2):140–142.

[36] Tian H, Xia M, Zhang S, et al. Acute calculous cholecystitis associated with hepaticartery pseudoaneurysm after percutaneous transhepatic gallbladder drainage in a diabetic patient[J]. Chin Med J ( Engl), 2014, 127(17): 3192–3194.

[37] Kasprzak A, Szmyt M, Malkowski W, et al. Analysis of immunohistochemical expression of proinflammatory cytokines (IL-1α,IL-6，and TNF-α)in gallbladder mucosa: comparative study in acute and chronic calculous cholecystitis[J]. Folia Morphol(Warsz),2016, 74(1):65–72. doi: 10.5603/FM.2015.0011.

[38] Cheng WC, Chiu YC, Chuang CH, et al. Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study [J]. Kaohsiung J Med Sci, 2014, 30(9):459–465. doi: 10.1016/j.kjms.2014.05.005.

[39] 張曉飛, 李亞斌, 王塬. 膽囊引流術(shù)后行膽囊切除術(shù)治療結(jié)石性膽囊炎的時(shí)機(jī)選擇[J]. 腹腔鏡外科雜志, 2016, 21(7):550–553.Zhang XF, Li YB, Wang Y. Timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute calculous cholecystitis[J]. Journal of Laparoscopic Surgery, 2016, 21(7):550–553.

[40] 趙紅光, 劉凱, 劉亞輝. 經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)后擇期行腹腔鏡膽囊切除術(shù)治療60歲以上急性重癥膽囊炎患者的最佳時(shí)機(jī)探討[J]. 臨床肝膽病雜志, 2017, 33(4):705–710. doi:10.3969/j.issn.1001–5256.2017.04.021.Zhao HG, Liu K, Liu YH. The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years [J]. Journal of Clinical Hepatology, 2017,33(4):705–710. doi:10.3969/j.issn.1001–5256.2017.04.021.