经皮经肝胆囊穿刺引流术联合择期腔镜胆囊切除术在老年中度急性胆囊炎中的应用观察  

Percutaneous transhepatic gallbladder drainage combined with elective laparoscopic cholecystectomy in elderly patients with moderate acute cholecystitis

作　　者：钟其焕 陈博艺[1] 邓国荣[1] 李荣[1] 李称才[1] 余勇[1] ZHONG Qi⁃huan;CHEN Bo⁃yi;DENG Guo⁃rong;YU Yong;LI Rong;LI Sheng⁃cai(Department of Hepatobiliary Surgery,Central People's Hospital of Zhanjiang,Zhanjiang,Guangdong 524045,China)

机构地区：[1]湛江中心人民医院肝外科

出　　处：《岭南现代临床外科》2020年第1期12-15,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省湛江市科技计划项目（2019B01199）

摘　　要：目的探讨经皮经肝胆囊穿刺引流术(PTGD)联合择期腔镜胆囊切除术(LC)在老年中度急性胆囊炎(AC)中的价值。方法根据患者的病情、意愿及经济情况等将95例患者分为PTGBD+LC组(35例)和LC组(60例)。LC组采用急诊LC治疗。PTGBD+LC组采用PTGD联合择期LC治疗。对比两组的LC围手术期评价指标、细胞免疫功能、体液免疫功能和并发症情况。结果与LC组相比,PTGBD+LC组中转开腹的构成比明显低,LC中失血量明显少,手术时间、LC后引流时间和LC后住院时间明显短(P<0.05)。PTGBD+LC组术后的IgA、IgG、IgM、CD3+、CD4+和CD4+/CD8+值均明显高于LC组(P<0.05)。PTGBD+LC组的并发症总发生率明显低于LC组(P<0.05)。结论PTGD联合择期LC可明显降低LC的难度和风险,提高LC的效果,加快老年中度AC患者的术后恢复,减轻免疫功能损伤和降低并发症发生率。Objective To investigate the value of percutaneous transhepatic gallbladder drainage(PTGD)combined with elective laparoscopic cholecystectomy(LC)in elderly patients with moderate acute cholecystitis(AC).Methods A total of 95 elderly patients with moderate AC were divided into PTGBD+LC group(35 cases)and LC group(60 cases)according to the patient􀆳s condition,willingness and economic situation.The LC group was treated with emergency LC.The PTGBD+LC group was treated with PTGD combined with selective LC.The perioperative evaluation index of LC,cellular immune func⁃tion,humoral immune function and complications in the two groups were compared.Results Compared with the LC group,the composition ratio of conversion to open surgery in the PTGBD+LC group was sig⁃nificantly lower,the blood loss in LC was significantly less,the operation time,drainage time after LC and hospitalization time after LC were significantly shorter(P<0.05 or 0.01).The values of IgA,IgG,IgM,CD3+,CD4+and CD4+/CD8+of the PTGBD+LC group were significantly higher than those of the LC group(P<0.05).The total incidence of complications of the PTGBD+LC group was significantly low⁃er than that of the LC group(P<0.05).Conclusion PTGD combined with selective LC can significant⁃ly reduce the difficulty and risk of LC,improve the effect of LC,accelerate the recovery of elderly pa⁃tients with moderate AC,reduce incidence of complications.

关 键 词：急性胆囊炎 经皮经肝胆囊穿刺引流术 腔镜胆囊切除术 应用价值 

分 类 号：R657.4[医药卫生—外科学]