经肝胆囊穿刺置管引流术后不同手术时机对急性胆囊炎患者手术效果的影响  

The influence of operation effects of timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis

作　　者：姜庆贺[1] 王爱芝[1] 崔文海[1] 

机构地区：[1]山东省济宁市兖矿集团总医院济东院区外二科,山东济宁272072

出　　处：《现代医学》2015年第7期832-836,共5页Modern Medical Journal

摘　　要：目的：分析经肝胆囊穿刺置管引流术（PTGD）后进一步手术的不同时机对急性胆囊炎患者手术效果的影响。方法：选取本院2013年6月至2014年10月收治的80例患者作为研究对象,回顾性分析其临床资料,然后按照PTGD手术与腹腔镜行胆囊切除术（LC）手术的时间间隔将其分为3组：第1组为PTGD术后2个月内行LC术者,第2组为PTGD术后2～4个月行LC术者,第3组为PTGD术后4个月后行LC术者。比较分析3组患者的转开腹率、手术时间、术中出血量、住院时间等指标。结果：3组患者从胆囊壁厚、转开腹率、术中的出血量及术后的并发症来看,第1组明显高于其余两组,差异具有统计学意义（P〈0.05）,但第2组与第3组差异无统计学意义（P〉0.05）;从术后的住院时间来看,第2组短于其余两组,差异具有统计学意义（P〈0.05）,但第1组与第3组差异无统计学意义（P〉0.05）;从手术时间来看,第1组明显长于第2组,差异具有统计学意义（P〈0.05）,但第3组与其余两组差异均无统计学意义（P〉0.05）。成功行LC术的平均胆囊壁厚、手术平均时间、术中平均出血量、术后平均住院时间及术后患者的症状再次发作率均明显少于LC术中转开腹的患者,差异均有统计学意义（P〈0.05）。结论：急性胆囊炎患者经PTGD手术治疗后2～4个月需择期进行LC手术,经B超检查,胆囊壁厚〈4.2 mm且病情稳定才可行LC术,这一策略可明显缩短患者的手术时间和住院时间,减少术中出血量,降低LC术转开腹率,降低术后伤口裂开或感染等各种并发症的发生率,提高患者的生活质量。Objective： To analyze the influence of operating effects of timing of further operation opportunity for the treatment of percutaneous transhepatic gallbladder drainage（ PTGD） in acute cholecystitis patients. Methods： 80 patients with acute cholecystitis from 2013. 6 to 2014. 10 in the hospital were chosen as the research subjects. Their clinical data were analyzed retrospectively. All of them have received laparoscopic cholecystectomy（ LC） after PTGD. According to the operation interval they were divided into 3 groups. Patients in the first group were within 2months to perform LC（ n = 25）,in the second group were between 2 and 4 months to perform LC（ n = 28）,in the third group were beyond 4 months to perform LC（ n = 27） retrospectively. The rate of patient conversion to surgery,the operation time,intraoperative losing blood and hospital stay time were analyzed and compared among three groups. Results： Compared the thickness of gallbladder wall,conversion to open surgery,intraoperative blood,postoperative complications,there was a significant difference between the first group and the other groups（ P〈0. 05）,but there was no significant difference between the second and the third group. Compared the operation time,there was a significant difference between the first and the second group. Compared the hospital stay time,there was a significant difference between the second and the other two groups（ P〈0. 05）. Average successful line of LC for the gallbladder wall thickness,average in average operation time,blood loss,postoperative symptoms in patients with the average length of hospital stay and postoperative again attack rate were significantly less than patients with LC transfer laparotomy operation,through statistical analysis,had significant difference（ P〈0. 05）.Conclusion： The timing to perform LC in acute cholecystitis patients should be between the 2-4 months interval after performing PTGD,the thickness of the gallbladder wall no more than 4. 2 mm and until it is i

关 键 词：经肝胆囊穿刺置管引流术 急性胆囊炎 手术时机 手术效果 

分 类 号：R657.41[医药卫生—外科学] R616.5[医药卫生—临床医学]