预康复干预在老年急性胆囊炎序贯性外科治疗中作用研究  

The role of prehabilitation interventions in the sequential surgical management of acute cholecystitis in the elderly patients-A retrospective cohort study

作　　者：葛云鹏 李晨[2] 刘媛[2] 吴明晓[2] 王丽娟[3] 刘庆梅 刘鹏[1] 李磊[1] 陈剑[1] 许静涌[1] 宋京海[1] GE Yun-peng;LI Chen;LIU Yuan(Department of General Surgery,Department of Hepato-billo-pancreatic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Ge-riatrics Chinese Academy of Medical Sciences,Beijing 100730,China;不详)

机构地区：[1]北京医院,国家老年医学中心,中国医学科学院老年医学研究院普通外科,肝胆胰外科,北京100730 [2]北京医院,国家老年医学中心,中国医学科学院老年医学研究院超声医学科,北京100730 [3]北京医院,国家老年医学中心,中国医学科学院老年医学研究院营养科,北京100730 [4]北京医院,国家老年医学中心,中国医学科学院老年医学研究院康复医学科,北京100730

出　　处：《中国实用外科杂志》2022年第9期1016-1020,共5页Chinese Journal of Practical Surgery

基　　金：中国食品科学技术学会食品科技基金项目(No.2021-M01);北京医院“科技新星”项目(No.BJ-2020-082)。

摘　　要：目的评估预康复干预在老年急性胆囊炎病人行急诊经皮经肝胆囊穿刺置管引流(PTGBD)和二期腹腔镜胆囊切除术(LC)间期的应用价值。方法收集2019年12月至2021年4月北京医院连续收治的年龄>65岁的胆囊结石合并急性胆囊炎一期行急诊PTGBD,门诊行预康复干预,二期行LC病人资料,作为预康复组;选取同时期年龄>65岁、连续入院的胆囊结石合并慢性胆囊炎行择期LC病人作为对照组。比较预康复组和对照组行LC时血实验室检查指标、手术时间、中转开放手术率、严重手术并发症发生率、术后住院日及住院总费用。结果预康复组共纳入30例病人,对照组纳入33例病人。预康复组相对于对照组,手术时间延长(80 min vs.60 min,P<0.01)、放置腹腔引流率高(50.00%vs.9.09%,P=0.001)、住院总费用增加(21507.29元vs.13693.07元,P<0.01)。但两组中转开放手术率(3.33%vs.0,P=0.223)、手术并发症发生率(6.67%vs.0,P=0.476)差异并无统计学意义。结论预康复干预可改善老年急性胆囊炎急诊PTGBD术后至二期LC期间的身体状态,使手术并发症和中转开腹的发生率接近择期LC。Objective To assess the value of prehabilitation interventions in elderly patients with acute cholecystitis undergoing emergency percutaneous transhepatic gallbladder puncture and drainage(PTGBD)and stage II laparoscopic cholecystectomy(LC)in the interval.Methods The data of consecutive patients aged>65 years with gallbladder stones combined with acute cholecystitis undergoing emergency PTGBD in phase I,prehabilitation intervention in outpatient,and LC in phase II were collected from December 2019 to April 2021 in our hospital as the prehabilitation group;patients aged>65 years with gallbladder stones combined with chronic cholecystitis undergoing elective LC in the same period were selected as the control group.The differences in blood chemistries at the time of LC,duration of surgery,conversion to open surgery,the incidence of surgical complications,postoperative hospital days,and total hospital costs were compared.Results A total of 30 patients were included in the prehabilitation group and 33 patients were included in the control group.The prehabilitation group had a longer operative time(80 min vs.60 min,P<0.01),a high rate of placing abdominal drainage(50.00%vs.9.09%,P=0.001),and an increased total hospital cost(RMB 21,507.29 vs.RMB 13,693.07,P<0.01)relative to the control group.However,there was no significant difference between the two groups in terms of the rate of conversion to open surgery,(3.33%vs.0%,P=0.223)and the rate of surgical complications(6.67%vs 0%,P=0.476).Conclusion Prehabilitation interventions improve physical status between emergency PTGBD and stage II LC in elderly patients with acute cholecystitis,bringing the incidence of surgical complications and intermediate open abdomen closer to that of elective LC.

关 键 词：急性胆囊炎 预康复 并发症 腹腔镜胆囊切除术 经皮经肝胆囊穿刺引流术 

分 类 号：R6[医药卫生—外科学]