PTGBD联合早期LC治疗老年高危急性胆囊炎的疗效观察  

Effect of PTGBD combined with early LC in the treatment of elderly patients with high-risk acute cholecystitis

作　　者：王翔翔[1] 刘洪[1] 柳凤玲 熊杰[1] 陈磊[1] 张军[1] 刘明忠[1] 陈刚[2] WANG Xiangxiang;LIU Hong;LIU Fengling;XIONG Jie;CHEN Lei;ZHANG Jun;LIU Mingzhong;Chen Gang(Department of Hepatobiliary Surgery, Dazhou Central Hospital, Dazhou, Sichuan 635000, P. R. China;Department of Hepatobiliary Surgery, Ganmei Hospital Affiliated to Kunming Medical University, Kunming 650011, P. R. China)

机构地区：[1]达州市中心医院肝胆外科,四川达州635000 [2]昆明医科大学附属甘美医院肝胆外科,昆明650011

出　　处：《中国普外基础与临床杂志》2019年第9期1061-1066,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生计生委科技项目(项目编号:18PJ506)

摘　　要：目的探讨经皮经肝胆囊穿刺引流术(PTGBD)联合早期腹腔镜胆囊切除术(LC)治疗老年高危急性胆囊炎的有效性及安全性。方法回顾性分析2015年1月至2019年1月期间达州市中心医院肝胆外科收治的128例老年高危急性胆囊炎患者的临床资料,其中行PTGBD+早期LC治疗62例,行PTGBD+延期LC治疗66例。比较2组患者的手术时间、术中出血量、中转开腹率、术后留管时间、术后住院时间、总住院时间及并发症发生情况,评估临床安全性。结果所有患者均成功行PTGBD术,72 h内症状有所缓解。2组患者的手术时间、术中失血量、中转开腹率、术后留管时间、术后住院时间及总并发症发生率比较差异均无统计学意义(P>0.05),但PTGBD+早期LC组的总住院时间短于PTGBD+延期LC组(P<0.001)。2组患者均无二次手术及死亡病例。术后128例获访,随访时间2~50个月,平均19个月。随访期间,患者未诉明显腹痛、腹胀、乏力、纳差、畏寒、发热、黄疸等不适。结论对于老年高危急性胆囊炎患者,PTGBD后全身状况良好的患者,早期行LC是一种安全且有效的治疗方法,不仅能缩短总住院时间,还能明显缩短带管时间,提高患者的生活质量,具有重要的临床应用价值。Objective To investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis. Methods The clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication. Results PTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2-50 months with a average of 19 months. Results of followup after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts. Conclusions For elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.

关 键 词：急性胆囊炎 高危 经皮经肝胆囊穿刺引流术 早期腹腔镜胆囊切除术 

分 类 号：R657.41[医药卫生—外科学]