经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性危重胆囊炎

Acute severe cholecystitis treated by percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy

目的 探讨经皮经肝胆囊穿刺引流术（PTGBD）联合腹腔镜胆囊切除术（LC）治疗急性危重胆囊炎的临床疗效.方法 对比分析PTGBD联合LC治疗组患者（n=35）和急诊LC治疗组患者（n=48）的围手术期相关资料.结果 LC手术时间（t=0.601,P=0.551）和术后住院时间（t=0.979,P=0.331）两组差异无统计学意义;术中失血量[PTGBD＋ LC组（79.43 ±46.27） ml,LC组（125.84±64.18） ml;t =3.641,P＜0.05];术后腹腔引流时间[PTGBD＋ LC组（3.29±1.58）d,LC组（4.63 ±2.31） d;t=3.131,P＜0.05];术后经口进食时间[PTGBD＋ LC组（2.91 ±1.58）d,LC组（4.21 ±2.22）d;t =2.669,P＜0.05]两组间比较差异有统计学意义;急诊LC组的中转开腹率,术中术后病死率,围手术期并发症发生率高于PTGBD联合LC组.结论PTGBD联合LC治疗急性危重胆囊炎的疗效确切,临床疗效优于急诊LC,是值得推广的治疗方式.

Objective To study the effect of percutaneous transhepatic gallbladder drainage （PTGBD） combined with laparoscopic cholecystectomy （LC） in treatment of acute severe cholecystitis.Method The perioperative data of patients treated with PTGBD combined with LC and patients treated with emergency LC were analyzed.Results There were no significant difference between the two groups on surgical duration （t =0.601,P =0.551） and postoperative hospital stay （t =0.979,P =0.331）.Blood loss [PTGBD ＋ LC （79.43 ± 46.27） ml,LC （125.84 ± 64.18） ml ; t =3.641,P ＜ 0.05],peritoneal drainage time [PTGDB ＋ LC （3.29 ± 1.58） d,LC （4.63 ± 2.31） d ; t =3.131,P ＜ 0.05] and postoperative oral intake time [PTGBD ＋LC （2.91 ±1.58）d,LC （4.21 ±2.22）d; t =2.669,P＜0.05] were significantly different between the two groups.The rate of laparotomy,mortality and postoperative complications in the emergency LC group were higher than those in the PTGBD combined with LC group.Conclusions PTGBD combined with LC in the treatment of acute severe cholecystitis was significantly better than emergency LC.