急性化脓性胆囊炎经皮经肝胆囊穿刺引流术后行腹腔镜胆囊切除时机的选择  

Timing choosing of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis after percutaneous transhepatic gallbladder drainage

作　　者：朱旭阳 朱学锋[1] 封华 ZHU Xuyang;ZHU Xuefeng;FENG Hua(Taixing People's Hospital in Jiangsu Province,Taixing,Jiangsu,225400)

机构地区：[1]江苏省泰兴市人民医院

出　　处：《实用临床医药杂志》2019年第19期73-75,共3页Journal of Clinical Medicine in Practice

摘　　要：目的探讨急性化脓性胆囊炎患者经皮经肝胆囊穿刺引流术(PTGD)后行腹腔镜胆囊切除时机的选择。方法选择在普外科接受治疗的42例急性化脓性胆囊炎患者作为研究对象,根据入院接诊先后顺序分为3组,各14例。A组急诊后立即进行腹腔镜胆囊切除术,B组在PTGD术后间隔60 d内进行二次手术,C组患者再次手术间隔时间长于60 d。比较3组患者术中各项基础情况以及术后情况。结果B、C组患者均经过2次成功手术,其中B组患者再次手术前胆囊壁厚度、手术时间以及手术出血量均显著优于A、C组(P<0.05);3组患者均出现不同术中情况及术后并发症,但经有效治疗均不影响最终手术结果。B组术后留院时间显著短于A、C组(P<0.05),中转开腹发生率及并发症发生率显著低于A、C组(P<0.05)。结论急性化脓性胆囊炎患者在PTDG术后60 d内再次进行腹腔镜胆囊切除手术是最佳选择,能够有效保障患者身体健康,缩短恢复时间,而过于延长手术间隔时间并无有效临床意义。Objective To explore the timing choosing of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis after percutaneous transhepatic gallbladder drainage(PTGD).Methods Forty-two patients with acute suppurative cholecystitis treated in General Surgery Department of our hospital were selected as study subjects.According to the order of admission,patients were divided into three groups,with 14 cases per group.Group A underwent laparoscopic cholecystectomy immediately after emergency treatment,group B underwent second operation within 60 days after PTGD operation,and group C re-operated with the interval of more than 60 days.After operation,the operative basic conditions and the conditions of the three groups were compared.Results Groups B and C underwent two successful operations,the thickness of gallbladder wall,the time of operation and the amount of bleeding before re-operation in group B were significantly better than those in the other two groups(P<0.05).There were intraoperative situations and postoperative complications in the three groups,but the operation was effectively treated.The length of hospital stay,the incidence of conversion to laparotomy and the incidence of complications were lower than groups A and C(P<0.05).Conclusion Implementation of laparoscopic cholecystectomy within 60 days after PTDG is the best choice for patients with acute suppurative cholecystitis,and it can effectively guarantee the patient's health,reduce the recovery time of patients.But it is of no significance to prolonging the operative time.

关 键 词：急性化脓性胆囊炎 经皮经肝胆囊穿刺引流术 腹腔镜胆囊切除 围术期 时机选择 

分 类 号：R657.4[医药卫生—外科学]