经腹腔及经肝脏胆囊穿刺引流对腹腔镜胆囊切除的影响  

Impact of transhepatic and transperitoneal cholecystostomy tube placement on laparoscopic cholecystectomy

作　　者：杨英祥[1] 夏念信 刘鹏[1] 安阳[1] 赵文超 祝建勇 李景波 邱宝安 刘彻 Yang Yingxiang;Xia Nianxing;Liu Peng(Department of Hepatobiliary Surgery,the Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心肝胰外科,北京100048

出　　处：《中华保健医学杂志》2023年第3期286-288,共3页Chinese Journal of Health Care and Medicine

基　　金：(首都市民健康培育)生物医药与生命科学创新培育研究(Z171100000417049)。

摘　　要：目的比较急性胆囊炎B超引导下不同穿刺置管路径对二期腹腔镜胆囊切除术的影响。方法回顾性分析2016~2022年解放军总医院第六医学中心115例急性胆囊炎行B超引导下胆囊置管引流并二期行腹腔镜胆囊切除的患者,按穿刺路径不同分经肝穿刺胆囊造瘘引流组67例,经腹腔穿刺胆囊造瘘引流组48例,对临床资料进行回顾性分析。结果两组临床资料差异无统计学意义(P>0.05),经肝组及经腹组均能较快解决急性胆囊炎炎症。经肝组疼痛指数在穿刺过程(3.1 vs.1.5,P=0.001)及术后12 h(4.6 vs.2.2,P=0.001)均低于经腹组;造瘘后24 h畏寒发热率低,较短的手术时间(119.3 vs.139.6 min,P=0.001),出血量少(72.9 vs.106.8 ml,P=0.001),较短的住院时间(14.4 vs.18.2 d,P=0.001),腹腔重度粘连少(39.5%vs.58.2%,P=0.049)。经腹组穿刺部位出血率优于经肝组(6.3%vs.20.8%,P=0.029)。在中转开腹率、胆囊次全切除及病理分级上两组差异无统计学意义(P>0.05)。结论急性胆囊炎行经肝穿刺胆囊造瘘引流较佳,二期腹腔镜胆囊切除手术用时短,术中出血少,术后住院时间短。Objective To compare the impact of percutaneous cholecystostomy(PC)related to the route of catheter placement on subsequent laparoscopic cholecystectomy(LC).Methods A retrospective analysis was conducted on 115 patients who underwent scheduled LC after PC between June 2016 and June 2022.The patients were divided into two groups based on the route of catheter placement.Group I consisted of 67 patients who underwent scheduled LC after percutaneous transhepatic gallbladder drainage(PHGD),while Group II consisted of 48 patients who underwent scheduled LC after percutaneous transperitoneal gallbladder drainage(PPGD).Clinical outcomes were compared between the two groups.Results Baseline demographic characteristics did not differ significantly between both groups(P>0.05).Both PHGD and PPGD were able to quickly resolve cholecystitis sepsis.Group I showed significantly higher efficacy than group II in terms of lower pain score during puncture(3.1 vs.1.5,P=0.001)and at 12 h follow-up(4.6 vs.2.2,P=0.001),lower rate of fever within 24 h after PC(13.4%vs.41.6%,P=0.001),shorted operation duration(119.3 vs.139.6 min,P=0.001),lower amount of intraoperative bleeding(72.9 vs.106.8 mL,P=0.001),shorter length of hospital stay(14.4 vs.18.2 d,P=0.001)and lower rate of severe adhesion(39.5%vs.58.2%,P=0.049).However,group II had significantly lower rate of local bleeding at PC site(6.3%vs.20.8%,P=0.029).No significant differences were noted between both groups regarding the conversion rate to laparotomy,rate of subtotal cholecystectomy,complications,and pathology.Conclusion B-mode-ultrasound-guided PHGD is superior to PPGD followed by LC for treatment of acute calculous cholecystitis,with shorter operating time,minimal amount of intraoperative bleeding,and short length of hospital stay.

关 键 词：急性胆囊炎 经皮经肝胆囊引流 经皮经腹膜腔胆囊引流 腹腔镜胆囊切除术 B超 

分 类 号：R657.4[医药卫生—外科学]