高危急性胆囊炎PTGD后行LC时机选择及手术延期的影响因素  

Timing of LC after PTGD in high-risk acute cholecystitis and influencing factors of delayed operation

作　　者：姜海[1] 李磊[1] 窦贺贺[1] 王如意 徐志鹏 邱兆磊[1] 王振杰[1] JIANG Hai;LI Lei;DOU He-he;WANG Ru-yi;XU Zhi-peng;QIU Zhao-lei;WANG Zhen-jie(Department of Emergency Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院急诊外科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2023年第8期1040-1044,共5页Journal of Bengbu Medical College

基　　金：安徽省高等学校自然科学研究重点项目(KJ2019A0385);蚌埠医学院科技项目(2021byzd122)。

摘　　要：目的:探讨高危急性胆囊炎病人实施经皮经肝胆囊穿刺引流术(PTGD)后行腹腔镜胆囊切除术(LC)的最佳间隔时间,并探讨手术延期的危险因素。方法:收集89例高危急性胆囊炎病人的病例资料,根据PTGD后行LC间隔时间不同分为:A组(时间≤4周),B组(4周<时间≤8周),C组(8周<时间≤12周)。并将PTGD穿刺管脱落、出血、穿刺相关感染等并发症发生率低的A组和B组病人合并为AB组(带管时间≤8周),与并发症发生率高的C组(8周<带管时间≤12周)再次进行分组比较。根据入院后收集病人临床资料分析PTGD后行LC的最佳时间,并探讨PTGD后影响手术延期的危险因素。结果:A组、B组、C组首次下床时间差异无统计学意义(P>0.05),B组手术后第一次进食流质时间、手术后出院时间、排气用时短(P<0.05),B组、C组手术时间短(P<0.05),A组、C组术后并发症高(P<0.05),C组中转开腹人数所占比例高(P<0.05),C组穿刺管脱落、出血、穿刺管相关感染人数比例高(P<0.05)。AB组(带管时间≤8周)与C组(8周<带管时间≤12周)单因素结果示:C组胆囊壁厚度、腹部手术史、结石、年龄、高血压史、冠心病史、糖尿病病史占比高(P<0.05)。多因素分析结果示:PTGD术前胆囊壁厚度≥6 mm、既往腹部手术史、年龄为影响病人延期手术的危险因素(OR>1)。结论:胆囊炎PTGD后最佳行LC手术间隔为4~8周。术前胆囊壁厚度≥6 mm、腹部手术史、高龄可能是病人手术间隔时间延长的危险因素。Objective:To investigate the optimal interval of laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGD)in high-risk patients with acute cholecystitis,and to explore the risk factors of delayed surgery.Methods:Case data of 89 patients with high-risk acute cholecystitis were collected and categorized according to the different intervals of LC after PTGD:group A(time≤4 weeks),group B(4 weeks<time≤8 weeks),and group C(8 weeks<time≤12 weeks).Patients in group A and group B with low incidence of PTGD puncture tube detachment,bleeding,puncture related infection and other complications were combined into group AB(catheter duration≤8 weeks),which were compared again with group C(8 weeks<catheter duration≤12 weeks)with high incidence of complications.Based on the clinical data collected after admission,the optimal time for LC after PTGD was analyzed,and the risk factors affecting the delay of surgery after PTGD were discussed.Results:There was no statistically significant difference in the first time of getting out of bed between group A,group B and group C(P>0.05).The time of first feeding fluid,discharge time and exhaust time after operation were shorter in group B(P<0.05),the time of operation in group B and group C was shorter(P<0.05),the postoperative complications in group A and group C were higher(P<0.05),the proportion of patients who switched to laparotomy in group C was higher(P<0.05),and the proportion of puncture tube shedding,bleeding and puncture tube-related infection in group C was higher(P<0.05).The single factor results showed that the proportion of gallbladder wall thickness,abdominal operation history,calculi,age,history of hypertension,history of coronary heart disease and history of diabetes in group C were higher than those in group AB(P<0.05).The results of multi-factor analysis showed that:preoperative gallbladder wall thickness≥6 mm,previous history of abdominal surgery and age were the risk factors for delaying surgery for PTGD(OR>1).Conclusions:The

关 键 词：胆囊炎 经皮经肝胆囊穿刺引流术 手术时机 影响因素 

分 类 号：R657.41[医药卫生—外科学]