超声介入在困难型胆囊切除围手术期中的应用策略及效果  

Application strategy and efficacy of ultrasonic intervention in perioperative period of difficult cholecystectomy

作　　者：张谦[1] 闫志永 徐亮 靳君华[1] 任建军[1] 乔建梁[1] Zhang Qian;Yan Zhiyong;Xu Liang;Jin Junhua;Ren Jianjun;Qiao Jianliang(Department of Hepatobiliary Pancreatic and Splenic Surgery,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China;Department of General Surgery,Fengzhen Hospital,Fengzhen 012100,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学附属医院肝胆胰脾外科,呼和浩特010050 [2]丰镇市医院普外科,内蒙古丰镇012100

出　　处：《中华老年多器官疾病杂志》2023年第11期826-829,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：内蒙古自治区科技计划项目(2022YFSH0098);内蒙古医科大学科技百万工程联合项目(YKD2018KJBW(LH)011)。

摘　　要：目的对比经皮经肝胆囊穿刺引流术(PTGD)联合延期胆囊切除术(LC)与直接行LC的治疗效果,探讨超声介入在困难型胆囊切除围手术期中的应用策略。方法选取2019年1月至2022年12月在内蒙古医科大学附属医院肝胆胰脾外科行困难型胆囊切除术的78例患者为研究对象。依据治疗方案不同将患者分为研究组30例及对照组48例。研究组PTGD术后2~4周行LC术;对照组直接行LC术。术中应用超声进行胆道探查,术后应用超声介入处理胆漏并发症。比较2组患者围手术期相关指标。采用SPSS 26.0统计软件进行数据分析。依据数据类型,组间比较分别采用独立样本t检验、χ^(2)检验或Fisher检验。结果与对照组相比,研究组患者年龄显著增高[(66.2±13.0)和(56.5±15.0)岁],年龄分布中≥60岁患者显著增多[76.7%(23/30)和45.8%(22/48)]、术后腹腔引流时间显著减少[(2.7±0.8)和(3.4±2.0)d],差异均有统计学意义(均P<0.05)。术中研究组患者中转开腹1例(3.3%),对照组中转开腹4例(8.3%)。术中2组共有7例患者胆囊三角解剖不清,采用超声进行胆道探查,明确局部解剖结构,手术均顺利完成。研究组1例患者术后2 d发生胆漏,给予超声引导下穿刺引流治疗后出院。结论PTGD联合LC可减少术后腹腔引流时间。超声介入在困难型胆囊切除围手术期的应用,可显著降低手术难度,提高手术安全性,有效处理术后并发症,值得推广应用。Objective To compare the therapeutic efficay of percutaneous transhepatic gallbladder drainage(PTGD)combined with delayed laparoscopic cholecystectomy(LC)versus early LC,and to explore the application strategy of ultrasonic intervention in the perioperative period of difficult cholecystectomy.Methods A total of 78 patients who underwent difficult cholecystectomy in the Affiliated Hospital of Inner Mongolia Medical University from January 2019 to December 2022 were recruited as the study subjects.According to different treatment plans,they were divided into study(n=30,LC surgery in 2-4 weeks after PTGD)and control(n=48,LC immediately after preoperative preparation)groups.Ultrasound was used for bile duct exploration intraoperatively and for treatment of bile leakage postoperatively.The perioperative related indicators were compared between the two groups.SPSS statistics 26.0 was used for statistical analysis.Data comparison between two groups was performed using independent sample t-test,χ^(2) or Fisher test depending on data type.Results The study group had more advanced age[(66.2±13.0)vs(56.5±15.0)years],higher ratio of those≥60 years old[76.7%(23/30)vs 45.8%(22/48)],and shorter duration of postoperative abdominal drainage[(2.7±0.8)vs(3.4±2.0)d]when compared with the control group(all P<0.05).Open conversion happened in one patient(3.3%)in the study group and four patients(8.3%)in the control group.There were seven patients in both groups having unclear anatomical structures of the Calot triangle,and the surgery was successfully completed after ultrasound exploration for the biliary tract to clarify the anatomical conditions.Only one patient from the study group developed bile leakage on the 2nd day after operation and was discharged after ultrasound-guided puncture and drainage.Conclusion PTGD combined with LC can shorten postoperative abdominal drainage time.The application of ultrasound intervention in the perioperative period of difficult cholecystectomy can significantly reduce surgical difficulty,im

关 键 词：介入[性]超声 困难型胆囊切除 围手术期 应用策略 

分 类 号：R445.1[医药卫生—影像医学与核医学] R605[医药卫生—诊断学]