PTGD后不同时间行LC治疗急性结石性胆囊炎患者疗效研究  

Laparoscopic cholecystectomy,shortly or a little longer after PTGD in the treatment of patients with acute calculous cholecystitis?

作　　者：黄昱[1] 王卓 任承纲 张耀[1] 刘杨旸 樊华[2] 何梅峰 Huang Yu;Wang Zhuo;Ren Chenggang(Department of General Surgery,Jiangong Hospital,Beijing 100054,China)

机构地区：[1]北京市健宫医院普外科,100054 [2]首都医科大学附属北京朝阳医院肝胆外科

出　　处：《实用肝脏病杂志》2023年第4期568-571,共4页Journal of Practical Hepatology

基　　金：吴阶平医学基金会临床科研专项资金资助项目(编号:320.6750.2621-07-22)。

摘　　要：目的探讨采用经皮经肝胆囊穿刺引流术(PTGD)后不同时间行腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎(ACC)患者的疗效。方法2019年3月~2022年1月我院收治的107例ACC患者,将其分为两组,均常规行PTGD术,其中A组51例在PTGD术后2个月内行LC术,B组56例在PTGD术2个月后行LC术治疗。使用彩色多普勒超声诊断仪检测胆囊壁厚度和胆囊橫径,采用半定量固相免疫测定法检测血清降钙素原(PCT)水平,采用ELISA法检测血清C反应蛋白(CRP)和去甲肾上腺素(NE),采用化学发光法检测血清促肾上腺皮质激素(ACTH)和皮质醇(Cor)水平。结果在LC术前,B组胆囊壁厚度为(3.8±0.4)mm,显著小于A组[(4.1±0.5)mm,P<0.05];B组手术时间、总住院时间和术中出血量分别为(78.2±9.5)min、(7.9±1.3)d和(53.4±6.9)mL,显著短于或少于A组[分别为(98.7±10.8)min、(10.2±2.1)d和(87.5±9.2)mL,P<0.05];在LC术后,B组血WBC、血清PCT和CRP水平分别为(6.4±0.7)×10^(9)/L、(0.0±0.0)ng/ml和(4.7±1.7)mg/L,显著低于A组[分别为(7.2±0.8)×10^(9)/L、(1.3±0.2)ng/ml和(61.2±5.8)mg/L,P<0.05];在LC术后72 h,B组血清ACTH水平为(84.3±2.8)ng/L,显著低于A组[(110.4±4.1)ng/L,P<0.05]。结论在PTGD术2个月后行LC术治疗ACC患者效果好,可缩短手术时间,减轻术后炎症应激反应。Objective The aim of this study was to explore the shortly or a little longer laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGD)in the treatment of patients with acute calculous cholecystitis(ACC).Methods 107 patients with ACC were encountered in our hospital between March 2019 and January 2022,and were divided into group A(n=51),receiving LC within two months after PTGD,and group B(n=56),receiving LC two months after PTGD.The thickness of gallbladder wall and diameter of gallbladder were detected by using color Doppler ultrasound.Serum procalcitonin(PCT)level was measured by semi-quantitative solid-phase immunoassay,and serum C-reactive protein(CRP)and norepinephrine(NE)levels were assayed by ELISA.Serum adrenocorticotropic hormone(ACTH)and cortisol(Cor)levels were detected by chemiluminescence.Results The gallbladder wall thickness before LC in group B was(3.8±0.4)mm,significantly thinner than[(4.1±0.5)mm,P<0.05]in group A;the surgical time,total hospital stay,and intraoperative blood loss in group B were(78.2±9.5)min,(7.9±1.3)d and(53.4±6.9)mL,significantly shorter or less than[(98.7±10.8)min,(10.2±2.1)d and(87.5±9.2)mL,respectively,P<0.05]in group A;after LC operation,the white blood cell counts,serum PCT and CRP levels in group B were(6.4±0.7)×10^(9)/L,(0.0±0.0)ng/ml and(4.7±1.7)mg/L,all significantly lower than[(7.2±0.8)×10^(9)/L,(1.3±0.2)ng/ml and(61.2±5.8)mg/L,respectively,P<0.05]in group A;72 hours after LC,serum ACTH level in group B was(84.3±2.8)ng/L,much lower than[(110.4±4.1)ng/L,P<0.05]in group A.Conclusion The relatively late LC after PTGD in the treatment of patients with ACC might get a better efficacy,which could shorten the surgical time and relieve the postoperative inflammatory stress response.

关 键 词：急性结石性胆囊炎 经皮经肝胆囊穿刺引流术 腹腔镜胆囊切除术 治疗 

分 类 号：R657.4[医药卫生—外科学]