经皮肝胆囊穿刺引流术联合腹腔镜胆囊切除手术治疗急性重症胆囊炎的临床疗效分析

Clinical efficacy of PTGBD combined with LC in the treatment of acute critical cholecystitis

目的探讨经皮肝胆囊穿刺引流术(PTGBD)联合腹腔镜胆囊切除手术(LC)治疗高危急性胆囊炎患者的临床效果。方法选取2013年1月-2016年4月在解放军总医院肝胆外科手术治疗147例急性危重胆囊炎患者进行回顾性分析,根据患者LC术前是否接受PTGBD治疗分为联合组71例、LC组76例,对比两组患者的围手术期指标、术后实验室指标的差异。结果联合组术中失血(80.3±18.2)ml、腹腔引流时间(3.5±1.2)d、进食时间(3.0±1.1)d均显著的低于LC组(116.4±24.6)ml、(4.3±1.5)d、(4.2±1.5)d,差异均有统计学意义(P<0.05);两组患者手术时间、术后住院时间比较差异无统计学意义;联合组和LC组患者治疗前的体温、WBC计数、血清碱性磷酸酶(ALP)、总胆红素(TBIL)、视觉模拟疼痛评分(VAS)差异均无统计学意义;术后72h,联合组白细胞计数(6.4±1.7)109/L、血清ALP(98.3±11.2)U/L、TBIL(22.7±7.1)μmol/L、VAS评分(1.6±0.8)分均显著低于LC组患者(8.9±2.5)109/L、(113.8±15.0)U/L、(27.0±8.3)μmol/L、(2.3±1.0)分,差异均有统计学意义(P<0.05);联合组和LC组患者肺部感染率、切口感染率、中转开腹率比较差异无统计学意义。结论 PTGBD联合LC治疗高危急性胆囊炎患者较单纯的LC手术更有利于患者术后恢复。

OBJECTIVE To investigate the clinical efficacy of percutaneous gallbladder puncture and drainage （PTG-BD） combined with laparoscopic cholecystectomy （LC） in the treatment of high-risk patients with acute cholecystitis.METHODS A total of 147 patients with acute severe cholecystitis treated in department of hepatobiliary surgery of General Hospital of PLA from Jan.2013 to Apr.2016 were selected for retrospective analysis.The patients were divided into combined groups （71 cases） and LC group （76 cases） according to whether the patients received PTGBD before LC operation,and the perioperative indicators and postoperative laboratory indicators of the patients in the two groups were compared.RESULTS The intraoperative blood loss of （80.3±18.2）ml,abdominal drainage time of（3.5± 1.2）d,and eating time of （3.0 ± 1.1）d of combined group of patients were significantly lower than those of LC group,which were （116.4±24.6）ml,（4.3±1.5）d,and （4.2±1.5）d,respectively （P〈0.05）.The operation time and hospitalization time after operation of the two groups of patients had no significant difference.The body temperature,WBC count,serum ALP,TBIL,and VAS score between combined group and LC group had no significant difference.At 72h after operation,the WBC count,serum ALP,TBIL,and VAS score of combined group were （6.4±1.7）〈109/L,（98.3± 11.2）U/L,（22.7±7.1）μmol/L,and （1.6±0.8） points,which were significantly lower than （8.9 ± 2.5） ＆#215; 109/L,（113.8±15.0）U/L,（27.0±8.3） mol/L,and （2.3±1.0）points of LC group （P〈0.05）.There was no significent difference in the incidence of pulmonary infection,incidence of incision infection and rate of conversion to lap（）rotomy between the patients in combined group and LC group.CONCLUSION PTGBD combined with LC in the treatment of high risk patients with acute chole cystitis is more conducive to postoperative recovery of patients with LC surgery.