经皮穿肝胆道引流序贯腹腔镜胆囊切除术治疗高龄急性化脓性胆囊炎临床观察  

Clinical Observation of Sequential Percutaneous Transhepatic Gallbladder Drainage and Laparoscopic Cholecystectomy in the Treatment of Acute Suppurative Cholecystitis in the Elderly

作　　者：章伟 张文俊 ZHANG Wei;ZHANG Wen-jun(The Second Department of General Surgery,the First People's Hospital of Chuzhou City,Chuzhou,Anhui 239000,China)

机构地区：[1]滁州市第一人民医院普通外科二病区,安徽滁州239000

出　　处：《解放军医药杂志》2022年第9期47-49,59,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：2018年度安徽省自然科学基金项目(1808085QH245)。

摘　　要：目的分析经皮穿肝胆道引流(PTGD)序贯腹腔镜胆囊切除术(LC)治疗高龄急性化脓性胆囊炎的效果。方法选择2019年1月—2020年5月收治的高龄急性化脓性胆囊炎60例,根据治疗方法分为研究组和对照组各30例。研究组给予PTGD序贯LC治疗,对照组给予急诊LC治疗。比较2组手术指标、血清炎性因子、并发症发生率及中转开腹率。结果研究组术中出血量少于对照组,胆囊壁厚度小于对照组,手术时间短于对照组(P<0.01)。研究组术后7 d白细胞计数、降钙素原、C反应蛋白水平均低于对照组(P<0.01)。研究组并发症发生率及中转开腹率均低于对照组(P<0.05)。结论PTGD序贯LC治疗高龄急性化脓性胆囊炎可有效缩短手术时间,减少术中出血量,抑制炎性介质释放,降低中转开腹率及并发症发生率。Objective To analyze the effect of sequential percutaneous transhepatic gallbladder drainage(PTGD)and laparoscopic cholecystectomy(LC)in the treatment of acute suppurative cholecystitis(ASC)in the elderly.Methods A total of 60 elderly patients with ASC who were treated from January 2019 to May 2020 were selected and divided into the research group(n=30)and the control group(n=30)according to the treatment method.The research group was given sequential PTGD and LC,and the control group was given emergency LC treatment.The surgical indexes,serum inflammatory factors,incidence of complication and rate of conversion to laparotomy were compared between the two groups.Results The intraoperative blood loss of the research group was less than that of the control group,the thickness of the gallbladder wall was smaller than that of the control group,and the duration of operation was shorter than that of the control group(P<0.01).The white blood cell count,procalcitonin and C reactive protein levels in the research group were lower than those in the control group at 7 days after operation(P<0.01).The rates of complications and conversion to laparotomy in the research group were lower than those in the control group(P<0.05).Conclusion Sequential PTGD and LC in the treatment of elderly patients with ASC can effectively shorten the duration of operation,reduce intraoperative blood loss,inhibit the release of inflammatory mediators,and reduce the rate of conversion to laparotomy and the incidence of complications.

关 键 词：胆囊炎 急性 经皮穿肝胆道引流 胆囊切除术 腹腔镜 C反应蛋白 手术后并发症 

分 类 号：R575.61[医药卫生—消化系统]