高龄急性胆囊炎早期手术与经皮引流后延期手术效果比较  

Comparison of early cholecystectomy versus delayed cholecystectomy after percutaneous transhepatic gallbladder drainage for over 80-year-old patients with acute cholecystitis

作　　者：牛强 侯克柱 姜小清 Niu Qiang;Hou Kezhu;Jiang Xiaoqing(Department of General Surgery,Shidong Hospital,University of Shanghai for Science and Technology,Shanghai 200433,China;Department I of Biliary Tract Diseases,Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]上海理工大学附属市东医院外一科,上海200433 [2]海军军医大学附属东方肝胆外科医院胆道一科,上海200433

出　　处：《中华肝胆外科杂志》2023年第11期847-850,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的对比80岁以上高龄急性胆囊炎早期胆囊切除术(EC),和经皮经肝胆囊穿刺引流(PTGD)后延期胆囊切除(DC)的治疗效果。方法回顾性分析2016年1月至2023年1月上海理工大学附属市东医院手术治疗的297例80岁以上急性胆囊炎患者临床资料,其中男性123例,女性174例,年龄(86.1±5.2)岁,分为EC组176例,PTGD+DC组121例。对比分析两组术前临床特征、手术时间、出血量、中转开腹手术比例、呼吸机支持比例、胆囊坏疽比例、腹腔引流时间、住院时间、重症监护室时间、并发症发生率。结果两组性别比例、年龄、美国麻醉师协会分级、胆囊炎严重程度、白细胞计数、血小板计数、血清降钙素原水平、合并症占比、发病至EC或发病至PTGD时间等比较,差异均无统计学意义(均P>0.05)。与PTGD+DC组相比,EC组术中出血多[(118±62)ml比(32±31)ml],手术时间长[(135±43)h比(61±31)h],胆囊坏疽比例高[23.2%(41/176)比9.9%(12/121)],呼吸机支持比例高[16.5%(29/176)比11.6%(14/121)],中转开腹比例高[22.7%(40/176)比9.1%(11/121)],腹腔引流时间长[(9.1±2.6)d比(3.8±2.3)d],住院时间长[(8.2±3.1)d比(6.1±2.2)d],重症监护室时间长[(9.0±0.3)h比(4.6±0.2)h],差异均有统计学意义(均P<0.05);另外术后胆漏、再出血、再手术、胆管损伤比例也高,差异均有统计学意义(均P<0.05)。结论相比早期手术,高龄急性胆囊炎患者采用PTGD+DC治疗,降低了手术风险和并发症发生,是高危患者简便有效的救治措施。Objective Comparison of early cholecystectomy(EC)and delayed cholecystectomy(DC)after percutaneous transhepatic gallbladder drainage(PTGD)for over 80-year-old patients with acute cholecystitis.Methods Clinical data of 297 over-80-year-old patients of with acute cholecystitis undergoing surgery in Shidong Hospital Affiliated to the University of Shanghai for Science and Technology from January 2016 to January 2023 were retrospectively analyzed,including 123 males and 174 females,aged(86.1±5.2)years.There were 176 cases in EC group and 121 in PTGD-DC group.Demographic data and perioperative outcomes were compared between the groups,including gender,age,ASA score,lab test,grades of acute cholecystitis,symptom,time before EC or PTGD,intraoperative blood loss,conversion,respiratory disfunction,gangrenous cholecystitis,abdominal drainage time,postoperative complication,hospital stay,intensive care time.Results The baseline characteristics were similar between EC and PTGD-DC groups,including demographics,ASA score,grades of acute cholecystitis,white blood cell counting,platelet counting,level of serum procalcitonin,time before EC or PTGD,and percentage of comorbidity.Compared to PTGD-DC group,Patients in DC group experienced more intraoperative blood loss(118±62 vs 32±31ml],longer operative time(135±43 vs 61±31)min],higher incidence of gangrenouscholecystitis[23.2%(41/176)vs 9.9%(12/121)],more respiratory support[16.5%(29/176)vs 11.6%(14/121)],more conversion to open surgery[22.7%(40/176)vs 9.1%(11/121)],longer postoperative abdominal drainage time(9.1±2.6 vs 3.8±2.3d],longer hospitalization(8.2±3.1 vs 6.1±2.2 d],longer intensive care(9.0±0.3 vs 4.6±0.2 h](all P<0.05).More complications were observed in EC group,such as bile leakage,postoperative bleeding,unscheduled reoperation,bile duct injury(all P<0.05).Conclusion PTGD and DC could lower the perioperative risk of elderly patients with acute cholecystitis.

关 键 词：胆囊炎 急性 高龄 胆囊切除术 经皮经肝胆囊穿刺引流 

分 类 号：R657.41[医药卫生—外科学]