急性期胆囊穿刺引流后择期腹腔镜胆囊切除术治疗胆囊炎的效果评价  

Evaluation of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in the management of acute cholecystitis

作　　者：刘亚奇[1] 许方婧伟 王欣[1] 吴全[1] 蔡轩 郑志学 柏楠[1] 赵景明[1] 毕敬涛[1] Yaqi Liu;Fangjingwei Xu;Xin Wang;Quan Wu;Xuan Cai;Zhixue Zheng;Nan Bai;Jingming Zhao;Jingtao Bi(Department of General Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Research and Development,China National Biotec Group,Beijing 100029,China)

机构地区：[1]北京积水潭医院普通外科,北京100035 [2]中国生物技术股份有限公司科研管理部,北京100029

出　　处：《中华普通外科杂志》2022年第6期430-433,共4页Chinese Journal of General Surgery

摘　　要：目的分析急性期经皮肝穿刺胆囊引流(percutaneous transhepatic gallbladder drainage,PTGBD)后择期腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)的困难程度及安全性。方法回顾性分析2018年1月至2021年1月在本院接受择期腹腔镜下胆囊切除术且在急性发作期达到TG18指南GradeⅡ级(中度)标准的病例共64例。根据急性期时是否曾接受PTGBD治疗,将病例分为急性期PTGBD后择期LC手术组21例,急性期未行PTGBD治疗后择期LC手术者43例。对比分析PTGBD治疗后择期LC的手术难度及效果。结果两组在住院时长、手术时间、出血量、手术难度评分等指标中差异均有统计学意义(均P<0.05)。急性期曾行PTGBD的LC病例住院时间(中位数7 d)和手术时间长(中位时间97 min),术中出血量多(中位数50 ml),手术难度较高(中位数13分)。PTGBD组的中转开腹率(4.8%)及术后并发症发生率(19.0%)与对照组相比差异无统计学意义(均P>0.05)。结论本研究未能显示PTGBD作为急性结石性胆囊炎手术前治疗的手段,对患者围手术期恢复具有优势。Objective To evaluate delayed laparoscopic cholecystectomy(DLC)after percutaneous transhepatic gallbladder drainage(PTGBD)in acute cholecystitis.Methods Clinical data of 64 patients who were diagnosed moderate(gradeⅡ)acute cholecystitis by the 2018 Tokyo Guidelines in acute phase and underwent delayed LC at our hospital from Jan 2018 to Jan 2021 were compared between two groups ie PTGBD treatment(21 cases)in acute stage before DLC and DLC without PTGBD group(43 cases).The difficulty score of TG18 was used to evaluated every surgical procedure of the cases by reviewing the operation videos.Results Patients in DLC after PTGBD group had a longer hospital stay and operation time,more blood lose and higher difficulty score than the DLC without PTGBD group(all P<0.05).There was no statistically significant difference in the conversion rate and morbidity rate between the two groups(P>0.05).Conclusion This study fails to show there is any if ever benefit of PTGBD before DLC over DLC without PTGBD in the management of GradeⅡacute cholecystitis.

关 键 词：胆囊切除术 腹腔镜 穿刺术 胆囊穿刺引流 

分 类 号：R657.41[医药卫生—外科学]