PTGD后早期、晚期行腹腔镜胆囊切除术对急性重症胆囊炎病人炎性反应和肝功能的影响  

Effects of early and late laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage on inflammatory responses and liver functions in patients with acute severe cholecystitis

作　　者：丁瑞利 王保富[1] 陈之强[1] Ding Ruili;Wang Baofu;Chen Zhiqiang(Department of Surgery,Beijing Shunyi District Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院外科,北京101300

出　　处：《腹部外科》2021年第6期432-437,共6页Journal of Abdominal Surgery

基　　金：首都卫生发展科研专项基金项目(2019-4024-03)。

摘　　要：目的观察经皮经肝胆囊穿刺置管引流术(percutaneous transhepatic gallbladder drainage,PTGD)拔管后早期、晚期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对急性重症胆囊炎病人炎性反应和肝功能的影响。方法前瞻性选择北京市顺义区医院2019年1月至2020年12月116例急性胆囊炎病人作为研究对象,采用隐匿数字随机法分为两组,PTGD拔管后早期(引流管拔除后72 h)行LC的58例病人设为LC早期组,PTGD拔管后晚期(引流管拔除后14~30 d)行LC的58例病人设为LC晚期组,比较两组LC术前、术后24 h炎性反应程度和肝功能。结果两组PTGD引流时间、术中出血量、术后肛门排气时间差异均无统计学意义(P>0.05)。LC晚期组LC手术时间、术后住院时间明显长于LC早期组,差异均有统计学意义(P<0.05)。LC术后24 h总胆红素(TBIL)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、丙氨酸转氨酶(ALT)、γ-谷氨酰转移酶(GGT)水平均较LC术前明显降低,差异均有统计学意义(P<0.05)。LC早期组LC术后24 h的TBIL、AST、ALP、ALT、GGT水平均低于LC晚期组,差异均有统计学意义(P<0.05)。LC术后24 h肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-1、IL-6、IL-10水平均高于LC术前,超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平均低于LC术前,差异均有统计学意义(P<0.05)。LC早期组LC术后24 h的hs-CRP、PCT、TNF-α、IL-1、IL-6水平均低于LC晚期组,差异均有统计学意义(P<0.05)。两组LC术后24 h IL-10水平差异无统计学意义(P>0.05)。LC早期组胆漏、胆道损伤等并发症发生率为5.17%(3/58),明显低于LC晚期组的17.24%(10/58),差异均有统计学意义(P<0.05)。LC早期组中转开腹率为5.17%(3/58),LC晚期组为3.45%(2/58),差异无统计学意义(P>0.05)。结论PTGD拔管后早期行LC可减轻炎性反应程度,有效保护肝功能,缩短病人手术和住院时间,降低术后并发症的发生率。Objective To explore the effects of early and late laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGD)extubation upon inflammatory responses and liver functions of patients with acute severe cholecystitis(ASC).Methods From January 2019 to December 2020,116 ASC patients were prospectively selected as research subjects.They were divided randomly into two groups of early and late LC(14-30 days vs.72 h after removing drainage tube)by concealed number method(n=58 each).LC was performed early after PTGD extubation(72 h after removing drainage tube).Two groups were compared with regards to degrees of inflammatory reactions and liver functions at pre/post-LC 24 h.Results No statistically significant inter-group differences existed in PTGD drainage time,intraoperative volume of blood loss or postoperative anal exhaust time(P>0.05).Operative duration and postoperative hospital stay significantly longer in late LC group than those in early LC group and the difference was statistically significant(P<0.05).The levels of total bilirubin(TBIL),aspartate aminotransferase(AST),alkaline phosphatase(ALP),alanine aminotransferase(ALT)and gamma-glutamyl transferase(GGT)at 24 h post-LC were significantly lower than those pre-LC and the difference was statistically significant(P<0.05).The levels of TBIL,AST,ALP,ALT and GGT at 24 h post-LC were lower in early LC group than those in late LC group and the difference was statistically significant(P<0.05).The levels of tumor necrosis factor-alpha(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6)and interleukin-10(IL-10)at 24 h post-LC were higher than those pre-LC and the levels of high sensitivity-C reactive protein(hs-CRP)and procalcitonin(PCT)were lower than those pre-LC(P<0.05).The levels of hs-CRP,PCT,TNF-α,IL-1 and IL-6 at 24 h post-LC were lower in early LC group than those in late LC group and the difference was statistically significant(P<0.05).No significant inter-group difference existed in the level of IL-10 at 24 h post-LC(P>0.05).The incid

关 键 词：经皮经肝胆囊穿刺置管引流术 早期腹腔镜手术 急性胆囊炎 炎性反应 肝功能 

分 类 号：R657.4[医药卫生—外科学]