腹腔镜胆囊切除术与经皮导管引流术治疗高危急性胆囊炎患者的疗效评估  

Efficacy evaluation of laparoscopic cholecystectomy and percutaneous catheter drainage in high-risk patients with acute cholecystitis

作　　者：邹正东[1] 陈波 ZOU Zhengdong;CHEN Bo(Hepatobiliary Surgery Department,Ziyang People's Hospital,Ziyang Sichuan 641300,China)

机构地区：[1]资阳市人民医院肝胆外科,四川资阳641300

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1170-1174,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2020年四川省卫生和计划生育委员会科研课题(编号:20ZD003)。

摘　　要：目的探讨腹腔镜胆囊切除术与经皮导管引流术治疗高危急性胆囊炎患者的疗效。方法选择2015年2月23日—2021年1月30日资阳市人民医院肝胆外科收治的134例高危急性胆囊炎患者,分为腹腔镜胆囊切除组(n=66)和经皮导管引流组(n=68)。高危被定义为急性生理评估和慢性健康评估Ⅱ(APACHEⅡ)评分为7分或更高。主要终点是1年内死亡和主要并发症的发生,包括1个月内感染和心肺并发症,1年内需要再次干预(必须与急性胆囊炎相关的手术、放射或内镜检查),或复发1年内胆道疾病。分析两组患者的临床资料、手术情况及治疗结果。结果①两组基线资料比较差异无统计学意义(P>0.05)。②64例接受腹腔镜胆囊切除术。1例因伴胆管炎需接受内镜逆行胰胆管造影。1例患者因低钠血症接受保守治疗,2例在出院数周后接受选择性胆囊切除术,11例(17.2%)患者腹腔镜手术转为开腹胆囊切除术。68例接受经皮导管引流,其中65例(95.6%)手术成功,其余3例患者放射科医师未能将经皮管放入胆囊腔,其中2例患者接受了保守治疗,直到症状消失,1例患者因胆囊穿孔和造影剂外渗导致严重腹痛而需要紧急胆囊切除术。③腹腔镜胆囊切除术和经皮导管引流组的病死率无统计学意义(3.0%vs.8.8%,P=0.270):分配给胆囊切除术的66例患者中有8例(12.1%)和分配到经皮导管引流组68例患者中有44例(64.7%)出现主要并发症(风险比0.2,95%置信区间0.1~0.4;P<0.001)。经皮导管引流组有45例患者(66.2%)需要再次介入治疗,而胆囊切除组有8例患者(12.1%)需要再次介入治疗(P<0.001)。经皮导管引流组胆道疾病复发率高于腹腔镜胆囊切除组(52.9%vs.4.5%,P<0.001)。中位住院时间长于腹腔镜胆囊切除组(9 d vs.5 d,P<0.001)。结论与经皮导管引流相比,腹腔镜胆囊切除术治疗高危急性胆囊炎患者的并发症发生率和胆道疾病的复发率更低、住院时间更短,�Objective To evaluate the efficacy of laparoscopic cholecystectomy and percutaneous catheter drainage in the treatment of high-risk patients with acute cholecystitis.Methods One hundred and thirty-four high-risk acute cholecystitis patients admitted to the Hepatobiliary Department of Ziyang People's Hospital from February 23,2015 to January 30,2021 were selected and randomly assigned to the laparoscopic cholecystectomy group(n=66)and the percutaneous catheter drainage group(n=68).High risk was defined as an acute physiological assessment and a chronic health assessment II(APACHE II)score of 7 or higher.The main endpoint was death within one year and the occurrence of major complications,including infection and cardiopulmonary complications within one month,requiring further intervention within one year(which must be related to surgery,radiation,or endoscopy for acute cholecystitis),or recurrence of biliary tract disease within one year.The clinical data,surgical conditions,and treatment outcomes of two groups of patients were analyzed.Results(1)There was no significant difference in baseline data between the two groups(P>0.05).(2)64 patients underwent laparoscopic cholecystectomy.One case needed endoscopic retrograde cholangiopancreatography because of cholangitis.One patient received conservative treatment for hyponatremia.They underwent selective cholecystectomy several weeks after discharge.In 11 patients(17.2%),laparoscopic surgery must be converted to open cholecystectomy.68 patients received percutaneous catheter drainage.Among them,65 cases(95.6%)were operated successfully.The radiologist of the remaining 3 patients failed to put the percutaneous tube into the gallbladder cavity;Two patients received conservative treatment until the symptoms disappeared,and one patient needed emergency cholecystectomy because of severe abdominal pain caused by gallbladder perforation and contrast agent extravasation.(3)There was no significant difference in mortality between laparoscopic cholecystectomy and percutaneous ca

关 键 词：腹腔镜胆囊切除术 经皮导管引流术 高危急性胆囊炎 疗效评估 

分 类 号：R575.61[医药卫生—消化系统] R616.2[医药卫生—内科学]