PTGBD序贯择期LC治疗急性胆囊炎的最佳时机探讨  

The optimal timing of sequential elective laparoscopic cholecystectomy for acute cholecystitis after percutaneous transhepatic gallbladder drainage

作　　者：刘洪[1] 甘雪梅[2] 孙建明[1] 张代忠[1] 赵宇[1] 杨中秋 柳凤玲 熊杰[1] 张军[1] LIU Hong;GAN Xuemei;SUN Jianming;ZHANG Daizhong;ZHAO Yu;YANG Zhongqiu;LIU Fengling;XIONG Jie;ZHANG Jun(Department of Hepatobiliary Surgery,Dazhou,Sichuan 635000,China;Department of Hepatology,Dazhou Central Hospital,Dazhou,Sichuan 635000,China)

机构地区：[1]达州市中心医院肝胆外科,四川达州635000 [2]达州市中心医院肝病科,四川达州635000

出　　处：《肝胆胰外科杂志》2023年第2期77-84,共8页Journal of Hepatopancreatobiliary Surgery

基　　金：成都中医药大学“杏林学者”学科人才科研提升计划项目(YYZX2020112)。

摘　　要：目的探讨经皮经肝胆囊穿刺引流(PTGBD)序贯择期腹腔镜胆囊切除术(LC)治疗急性胆囊炎的最佳时机。方法回顾性分析2016年1月至2022年2月达州市中心医院肝胆外科收治的114例急性胆囊炎患者临床资料,根据择期LC手术难度,将患者分为非困难组(n=62)和困难组(n=52),比较两组相关临床及生化指标情况。通过PTGBD-LC间隔时间预测手术难度绘制ROC曲线,得出截断值。以该值为节点分为短间隔组(n=58)和长间隔组(n=56)两组,比较两组患者围手术期指标情况。以PTGBD-LC间隔时间为自变量、困难LC比例为因变量,进一步绘制拟合曲线,研究PTGBD-LC间隔时间与LC难度之间的关系。结果本研究共纳入114例患者,非困难组患者的查尔森合并症指数、上腹部手术史比例、生化指标(NLR、PLR、ALT和γ-GT)及手术时间明显低于困难组(均P<0.05),而PTGBD-LC间隔时间明显长于困难组(P<0.05)。以PTGBD-LC间隔时间预测手术难度绘制ROC曲线,得出AUC为0.778,截断值为53.5 d,当PTGBD-LC间隔时间>53.5 d时,困难LC比例、胆囊壁厚度、胆囊颈周围重度粘连率、胆囊坏疽或周围脓肿形成率、腹腔镜胆囊次全切除术(LSC)和(或)胆囊黏膜毁损术率、术中出血、手术时间、术后住院时间及术后并发症发生率明显降低(均P<0.05)。两组中转开腹率差异无统计学意义(P>0.05)。拟合曲线分析显示,在PTGBD-LC间隔时间为20.7 d时困难LC比例最高,随后逐渐降低,当PTGBD-LC间隔时间为84.7 d时困难LC比例最低,随后困难LC比例又再次上升。结论PTGBD-LC间隔时间与择期LC手术难度紧密相关,结合手术难度及患者生活质量考虑,PTGBD后择期LC最佳间隔时间为53.5~84.7 d。objective To explore the optimal timing of sequential elective laparoscopic cholecystectomy(LC)for acute cholecystitis after percutaneous transhepatic gallbladder drainage(PTGBD).Methods The clinical data of 114 patients with acute cholecystitis admitted to Dazhou Central Hospital between Jan.2016 and Feb.2022were retrospectively analyzed.According to the difficulty of sequential elective LC,patients were divided into non-difficult group(n=62)and difficult group(n=52),and the relevant clinical and biochemical indexes between the two groups were compared.ROC curve was drawn by predicting the difficulty of LC with the PTGBD-LC interval time,and the cut-off value was obtained.Taking this value as the node,patients were divided into shortinterval group(n=58)and long-interval group(n=56),and the perioperative indexes between the two groups were compared.Taking the PTGBD-LC interval time as the independent variable and the proportion of difficult LC as the dependent variable,the fitting curve is further drawn to study the relationship between the interval time of PTGBD-LC and the difficulty of LC.Results For non-difficult group,Charlson’s complication index,the proportion of upper abdominal surgery history,biochemical indexes(NLR,PLR,ALT andγ-GT)and operation time were significantly lower than those in the difficult group(all P<0.05),and the interval time of PTGBDLC was significantly longer than that in difficult group(P<0.05).The ROC curve was drawn by predicting the difficulty of LC with PTGBD-LC interval time.The cut-off value was 53.5 d(AUC=0.778).When the PTGBDLC interval time>53.5 d,the ratio of difficult LC,thickness of gallbladder wall,rate of severe adhesion around gallbladder neck,rate of gallbladder gangrene or surrounding abscess formation,rate of laparoscopic subtotal cholecystectomy(LSC)and(or)gallbladder mucosal destruction,intraoperative bleeding,operation time,postoperative hospitalization time and the incidence of postoperative complications,decreased significantly(all P<0.05).There was no signific

关 键 词：急性胆囊炎 经皮经肝胆囊穿刺引流 腹腔镜胆囊切除术 序贯治疗 手术时机 

分 类 号：R657.4[医药卫生—外科学]