经皮经肝胆囊穿刺引流术联合延期胆囊切除术治疗急性胆囊炎患者近期疗效研究  

percutaneous transhepatic gallbladder drainage and delayed laparoscopic cholecystectomy combination in the treatment of patients with acute cholecystitis

作　　者：周志林[1] 梅勇[1] 杨旭辉[1] 戴军[1] Zhou Zhilin;Mei Yong;Yang Xuhui(Department of General Surgery,Liyuan Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430077,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院普外科

出　　处：《实用肝脏病杂志》2019年第4期597-600,共4页Journal of Practical Hepatology

基　　金：湖北省自然科学基金资助项目(编号:2016CFB546)

摘　　要：目的观察经皮经肝胆囊穿刺引流术(PTGBD)联合延期腹腔镜胆囊切除术(LC)治疗急性胆囊炎患者的近期临床效果。方法2015年8月~2017年8月我院收治的94例急性胆囊炎患者被分为两组,47例观察组患者采取PTGBD联合延期LC治疗,另47例对照组采取急诊LC治疗。结果观察组手术时间为(83.2±34.1)min,显著短于对照组【(119.0±36.4)min,P<0.05】,手术失血量为(33.7±15.5)ml,显著少于对照组【(60.4±16.7)ml,P<0.05】,术后肛门排气时间为(23.5±6.6)h,显著短于对照组【(27.2±5.1)h,P<0.05】,术后腹腔引流时间为(3.4±2.0)d,显著短于对照组【(9.1±3.1)d,P<0.05】,而总住院时间为(11.2±4.7)d,显著长于对照组【(8.3±3.0)d,P<0.05】;观察组腔镜中转开腹率和直接开腹率分别为4.3%和0.0%,显著低于对照组的17.0%和12.8%(P<0.05);术后72h,观察组白细胞计数、谷丙转氨酶、谷草转氨酶和总胆红素水平显著低于对照组(P<0.05);观察组短期并发症发生率为8.5%,显著低于对照组的29.8%(P<0.05)。结论采取PTGBD联合延期LC治疗急性胆囊炎患者临床疗效确切,可有效降低腔镜手术中转开腹率和术后并发症发生率,临床上应尽量避免急诊行LC手术。Objective To observe the clinical efficacy of percutaneous transhepatic gallbladder drainage(PTGBD)and delayed laparoscopic cholecystectomy(LC)combination in the treatment of patients with acute cholecystitis(AC).Methods A retrospective study was conducted on 94 patients with AC admitted to our hospital between August 2015 and August 2017.47 patients in observation received PTGBD and delayed LC treatment,and another 47 in the control received emergent LC.Results In the observation group,the operation time was(83.2±34.1)min,significantly shorter than[(119.0±36.4)min,P<0.05]in the control,blood loss was(33.7±15.5)ml,much less than【(60.4±16.7)ml,P<0.05】in the control,the postoperative anal exhaust was(23.5±6.6)h,significantly shorter than【(27.2±5.1)h,P<0.05】in the control,the postoperative abdominal drainage was(3.4±2.0)d,significantly shorter than【(9.1±3.1)d,P<0.05】in the control,while total hospital stay was(11.2±4.7)d,significantly longer than【(8.3±3.0)d,P<0.05】in the control;the rates of conversion to open surgery and direct open surgery in observation group were 4.3%and 0.0%,significantly lower than 17.0%and 12.8%(P<0.05)in the control;72 hours after operation,the while blood cell counts,serum ALT,AST and bilirubin levels were significantly lower than those in the control(P<0.05);the incidences of short-term complications in the observation was 8.5%,much lower than 29.8%(P<0.05)in the control.Conclusion The application of PTGBD and thereafter delayed LC in the treatment of patients with AC is definitely efficacious,which might effectively reduce the conversion rate to open surgery and the incidence of post-operational Complications.

关 键 词：急性胆囊炎 经皮经肝胆囊穿刺引流术 腔镜下胆囊切除术 治疗 

分 类 号：R657.41[医药卫生—外科学]