急性胆囊炎经皮胆囊造瘘术后序贯腹腔镜胆囊切除术的最佳手术时机探讨  

Optimal surgical timing for sequential laparoscopic cholecystectomy following percutaneous cholecystostomy for acute cholecystitis

作　　者：张誉 王一鸣 王海 阿斯哈提·库万太 陈凯[1] ZHANG Yu;WANG Yiming;WANG Hai;Ashat Kwantai;CHEN Kai(Department of Hepatobiliary Pancreatic Surgery,The Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,P.R.China)

机构地区：[1]新疆医科大学第五附属医院肝胆胰腺外科,乌鲁木齐830000

出　　处：《中国普外基础与临床杂志》2024年第1期80-84,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨急性胆囊炎患者行经皮胆囊造瘘术后序贯腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的最佳手术时机,以期为临床提供参考。方法依据纳入和排除标准选择新疆医科大学第五附属医院2021年3月至2023年7月期间先行经皮胆囊造瘘术后延期行LC的患者,根据患者经皮胆囊造瘘术后到LC的时间间隔分成3组,分别为短间隔组(3~4周)、中间隔组(5~8周)及长间隔组(>8周),比较3组患者的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住重症加强护理病房(intensive care unit,ICU)、中转开腹、并发症发生及住院总费用方面的差异。结果本研究共纳入99例患者,其中短间隔组25例、中间隔组41例、长间隔组33例,3组患者在人口学特征、血常规、C反应蛋白、白细胞介素-6、纤维蛋白原、国际标准化比值、丙氨酸转氨酶、天冬氨酸转氨酶等及其他如基础疾病方面比较差异均无统计学意义(P>0.05)。3组患者在行经皮胆囊造瘘术后LC前的胆囊壁厚度以及行LC的手术时间、术中出血量、术后住院时间、总住院时间、引流管放置时间、引流管放置例数、入住ICU、中转开腹、并发症发生及住院总费用方面比较差异均有统计学意义(P<0.05),中间隔组在上述各个观察指标方面均优于短间隔组(P<0.05)和长间隔组(P<0.05),而短间隔组和长间隔组间仅在住院总费用方面差异有统计学意义(短间隔组高于长间隔组,P=0.019)。结论从本研究分析的结果看,经皮胆囊造瘘术后序贯LC的最佳时间间隔为5~8周,只是该结论需要进一步扩大样本或用多中心的数据验证。Objective To explore the optimal surgical timing of sequential laparoscopic cholecystectomy(LC)following percutaneous cholecystostomy(PC)in the patients with acute cholecystitis,so as to provide a clinical reference.Methods The patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria,who were categorized into 3 groups:the short interval group(3–4 weeks),the intermediate interval group(5–8 weeks),and the long interval group(>8 weeks)based on the time interval between the PC and LC.The gallbladder wall thickness before LC,operative time,intraoperative blood loss,postoperative hospitalization time,total hospitalization time,time and cases of drainage tube placement,admission to intensive care unit,conversion to open surgery,occurrence of complications,and total hospitalization costs were compared among the 3 groups.Results A total of 99 patients were enrolled,including 25 in the short interval group,41 in the intermediate interval group,and 33 in the long interval group.The data of patients among the 3 groups including demographic characteristics,blood routine,C-reactive protein,interleukin-6,fibrinogen,international standardized ratio,liver function indicators,and comorbidities had no statistical differences(P>0.05).The gallbladder wall thickness before LC and the operative time,intraoperative blood loss,postoperative hospitalization time,total hospitalization time,time and cases of drainage tube placement,admission to intensive care unit,conversion to open surgery,occurrence of complications,and total hospitalization costs during and after LC had statistical differences among the 3 groups(P<0.05).These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons(P<0.05),but which had no statistical differences except total hospitalization costs(P=0.019)between the short interval group and the long interval gr

关 键 词：急性胆囊炎 经皮胆囊造瘘术 腹腔镜胆囊切除术 手术时机 

分 类 号：R657.41[医药卫生—外科学]