经皮经肝胆囊穿刺引流术与腹腔镜胆囊切除术间隔时间对老年急性结石性胆囊炎手术效果的影响  

Effect of the Interval Between Percutaneous Transhepatic Gallbladder Puncture and Drainage and Laparoscopic Cholecystectomy on the Surgical Effect of Acute Calculous Cholecystitis in the Elderly

作　　者：胡家唯 陈志升 HU Jiawei;CHEN Zhisheng(Department of General Surgery,Shanghai Putuo District Central Hospital,Shanghai,200062,China)

机构地区：[1]上海市普陀区中心医院普外科,上海200062

出　　处：《中外医疗》2025年第8期30-34,共5页China & Foreign Medical Treatment

摘　　要：目的探究经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGBD)和腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)间隔时间对老年急性结石性胆囊炎(acute calculous cholecystitis,ACC)患者康复效果的影响。方法选取2020年3月—2023年12月上海市普陀区中心医院收治的90例老年ACC患者为研究对象,按照PTDBD与LC的间隔时间分为A组、B组与C组,其中A组(30例)患者手术间隔时间为<2个月,B组(30例)患者手术间隔时间为2~4个月,C组(30例)患者间隔时间>4个月。比较3组患者的手术指标、临床症状及并发症,并分析术前术后的白介素-6(interleukin 6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)。结果B组的术中失血量、导管留置时间、住院时间、手术时间较A组、C组更短,差异均有统计学意义(P均<0.05)。B组的凝血功能、白细胞、体温恢复时间、休克纠正时间较A组、C组更短,差异均有统计学意义(P均<0.05)。B组的并发症发生率为13.33%(4/30),略低于A组的20.00%(6/30)与C组的16.67%(5/30),差异无统计学意义(χ^(2)=1.723,P>0.05)。术后,B组的IL-6、TNF-α水平较A组、C组更低,与C组相比,A组的IL-6、TNF-α水平更低,差异均有统计学意义(P均<0.05)。结论PTGBD与LC的手术间隔时间为2~4个月对ACC的治疗效果最佳,能显著缩短腹腔镜导管留置时间、住院时间、手术时间,减少术中失血量,并能快速缓解临床症状,激起的炎症反应较少,不增加并发症,确保手术的安全性与有效性。Objective To explore the effect of interval time between percutaneous transhepatic gallbladder drainage(PTGBD)and laparoscopic cholecystectomy(LC)on the rehabilitation effect of elderly patients with acute calculous cholecystitis(ACC).Methods A total of 90 elderly patients with ACC admitted to Shanghai Putuo District Central Hospital from March 2020 to December 2023 were selected as the atudy objects.According to the interval between PTDBD and LC,they were divided into group A,group B and group C,the interval between operations of group A(30 patients)was less than 2 months,group B(30 patients)was 2-4 months,and group C(30 patients)was more than 4 months.The surgical indicators,clinical symptoms and complications of the three groups were compared,and the preoperative and postoperative interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were analyzed.Results Group B had intraoperative blood loss,catheter retention length,and shorter operation time than A and C groups,the differences were statistically significant(all P<0.05).The coagulation function,white blood cells,body temperature recovery time and shock correction time in group B were shorter than those in group A and group C,and the differences were statistically significant(all P<0.05).The incidence of complications in group B was 13.33%(4/30),which was slightly lower than 20.00%(6/30)in group A and 16.67%(5/30)in group C,and the difference was not statistically significant(χ^(2)=1.723,P>0.05).After operation,the levels of IL-6 and TNF-αin group B were lower than those in group A and group C,compared with group C,the levels of IL-6 and TNF-αin group A were lower,and the differences were statistically significant(all P<0.05).Conclusion The operation interval between PTGBD and LC is 2-4 months with the best effect on the treatment of ACC,which can significantly shorten the time of laparoscopic catheter,hospitalization time,reduce intraoperative blood loss,and quickly relieve clinical symptoms,stir up less inflammatory response,does not increase the compli

关 键 词：经皮经肝胆囊穿刺引流术 腹腔镜胆囊切除术 间隔时间 急性结石性胆囊炎 

分 类 号：R657.41[医药卫生—外科学]