急性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择  

Timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis

作　　者：邱明[1] 吴向未[2] 杨宏强[2] 刘国起 马杰[1] 张示杰[2] 

机构地区：[1]石河子大学医学院,新疆维吾尔自治区石河子市832000 [2]石河子大学医学院第一附属医院肝胆外科,新疆维吾尔自治区石河子市832000

出　　处：《实用医学杂志》2014年第18期2911-2914,共4页The Journal of Practical Medicine

基　　金：新疆生产建设兵团科技计划(编号:2013AB026);国家科技支撑计划(编号:2013BAI05B00)

摘　　要：目的：探讨急性胆囊炎患者行经皮经肝胆囊穿刺引流术后的进一步手术治疗的时机。方法：回顾性分析我院77例急性胆囊炎患者行经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage,PTGD）后联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的临床资料。按PTGD与LC的间隔时间分为三组,组1为PTGD后2个月内行LC的病例（n=11）,组2为PTGD后2-4个月内行LC的病例（n=36）,组3为PTGD后间隔4个月以上行LC的病例（n=30）。比较三组中转率、术中出血量、手术时间、术后住院时间等。结果：三组间,LC前胆囊壁厚、LC转开腹例数、术中出血量、手术时间、术后住院时间、术后并发症的比较,差异有统计学意义（P〈0.05）。结论：急性胆囊炎患者经PTGD治疗2-4个月择期手术,B超检查胆囊壁厚〈0.42 cm,并且患者病情稳定后行LC,能较好地缩短手术时间,减少术中出血量,降低LC转开腹率,缩短术后住院时间,降低患者术后切口裂开、感染等并发症的发生,提高患者的生活质量。Objective To investigate thetiming offurtheroperative opportunity for the treatmentofpercutaneous transhepatic gallbladder drainage （PTGD）in patients with acute cholecystitis. Methods Theclinical data of 77 patients with acute cbolecystitis who received laparoscopic cholecystectomy after PTGD wereanalyzed retrospectively. According to the interval, Seventy-seven cases weredivided into 3 groups. The patientsin the first （n = 11）, second （n = 36）, third （n = 30） group performed LC were within 2 m, during 2 - 4 m,and beyond 4 m, retrospectively. The rate of conversion to surgery, intraoperative blood, operation time andhospital stay were compared among the three groups. Results There was significant difference in the thicknessof gallbladder wall before LC, conversion to open surgery, intraoperative blood, operation time, hospital stayandpostoperative complications among 3 groups （P 〈 0.05）. Conclusion The timing for LC in patients withacute cholecystitis should be within the 2 - 4 mintervalafler PTGD, the thickness of gallbladder wall less than0.42 cm and stable condition. On average LC appearsafe and effective with short operation time, less blood loss,low rate of conversion to open surgery and postoperative complications, reduced hospital stay, and results inbetter quality of life.

关 键 词：急性胆囊炎 经皮经肝胆囊穿刺引流术 手术时机 高危 

分 类 号：R657.4[医药卫生—外科学]