胆囊穿刺置管造口引流术对老年急性化脓坏疽性胆囊炎患者的临床疗效及安全性

Clinical efficacy and safety of percutaneous transpepatic galbladder drainage in elderly patients with acute suppurative gangrenous cholecystitis

目的探讨穿刺置管造口引流术对老年急性化脓坏疽性胆囊炎患者的临床疗效及安全性。方法选取2011年10月至2016年12月在本院治疗的46例老年急性化脓坏疽性胆囊炎患者进行回顾性分析,其中23例患者采用腹腔镜下胆囊切除术进行治疗,作为对照组;另外23例患者采用胆囊穿刺置管造口引流术结合腹腔镜下胆囊切除术进行治疗,作为试验组。随访6个月,观察两组患者的治疗情况及并发症发生情况。结果试验组患者手术时间、术中出血量、休克纠正时间、体温恢复时间、白细胞恢复时间及凝血功能恢复时间等明显低于对照组,具有统计学意义(P<0.05);试验组患者发生胆管损伤、腹腔内出血、胆汁漏、皮下气肿等并发症发生率(4.3%)明显低于对照组(26.10%),具有统计学意义(P<0.05);术后3个月经超声复查两组患者均未发生胆管狭窄、残余胆囊等情况。结论胆囊穿刺置管造口引流术联合腹腔镜胆囊切除术用于老年急性化脓坏疽性胆囊炎患者的治疗能够有效的减少并发症,具有良好的临床效果和安全性。

Objective To study the Clinical efficacy and safety of percutaneous transpepatic galbladder drainage in elderly pa- tients with acute suppurative gangrenous cholecystitis. Methods From October 2011 to August 2016, 46 case elderly patients with a- cute suppurative gangrenous cholecystitischolecystitis in our hospital were selected. 23 patients were treated with laparoscopic cholecys- tectomy as control group, while 23 patients underwent percutaneous transpepatic galbladder drainage with laparoscopic cholecystectomy as experimental group. The patients were followed up for 6 months. The treatment and complications of the two groups were observed. Results The operation time, intraoperative blood loss, the time of shock correction, the recovery time of body temperature, the recov- ery time of white blood cell and the recovery time of coagulation function of the experimental group were significantly lower than the con- trol group, with statistical significance （P 〈 O. 05 ） ; The incidence of bile duct injury, abdominal bleeding, bile leakage, subcutaneous emphysema and other complications of the experimental group（4. 3% ） were significantly lower than the control group（26. 1% ）, with statistical siguificance（P 〈0. 05） ; After 3 months of treatment, the patients in the two groups were not found to have bile duct stricture, residual gallbladder and so on. Conclusion The treatment of elderly patients with acute suppurative gangrenous cholecystitischolecystitis with gallbladder percutaneous puncture can effectively reduce the complications, and has good clinical effect and safety.