经皮经肝胆囊穿刺造瘘术治疗老年重症结石性胆囊炎的临床疗效分析

The clinical effect analysis of percutaneous trans hepatic gallbladder fistula in elderly patients with severe gallstone cholecystitis

目的分析老年性的重症结石性胆囊炎患者采用经皮经肝胆囊穿刺造瘘术治疗的疗效情况。方法选择2015年1月-2016年1月期间前来笔者单位就诊的84例老年重症结石性胆囊炎患者,根据随机的原则将患者平均分为两组,A组是在行经皮经肝胆囊穿刺造瘘术基础上联合腹腔镜行胆囊切除术,B组行腹腔镜胆囊切除术,对比两组患者在手术方案后的手术相关指标、住院时间、实验室指标改善时间以及并发症发生率。结果在手术指标的对比中可知,A组患者的手术耗费时间、术中出血量两项指标要明显低于B组患者,差异有统计学意义(P<0.05)。此外,A组的术后平均住院天数是(9.56±2.66)d,明显短于B组(18.34±3.68)d,差异有统计学意义(P<0.05)。A组患者各项时间指标相比于B组患者均显著要短(P<0.05)。另外,A组不良反应的总发生率9.52%(4/42),而B组则高达38.1%(16/42),两组对比差异有统计学意义(P<0.05)。对比两组患者术后白细胞、C反应蛋白、谷丙转氨酶、谷草转氨酶等指标,发现A组患者的各项指标改善情况要明显优于B组,P<0.05。结论对于老年重症结石性胆囊炎患者,可以先给予经皮经肝胆囊穿刺造瘘术,随后再行腹腔镜下胆囊切除术,能够显著缩短手术时间,降低手术难度,缩短患者术后恢复时间,从而减少术后住院天数,并且能够有效降低术后相关并发症发生率。

Objective To analyze the curative effect of PTGCD in elderly patients with severe gallstone cholecystitis. Methods 84 cases of elderly patients with severe gallstone cholecystitis treated in our hospital from January 2015 to January 2016 were selected. All cases were divided into two groups, 42 cases for each group. Group A was performed on the basis of PTGCD combined with laparoscopic cholecystectomy, while group B were treated with laparoscopic cholecystectomy. The operation index, hosptial stay, improvement of laboratory indexes and incidence of complications between two groups were compared after the surgical program. Results In the operation indexes, the operation time and amount of bleeding during operation of group A were significantly lower than those of group B, the difference was statistically significant（P〈0. 05）. Besides, the postoperative average length of stay in group A was（9.56 ±2.66）d which was significantly shorter than that in group B（18.34±3.68）d, the difference had statistical significance（P〈0.05）. The time indicators in group A were remarkably shorter compared to group B（P〈0. 05）. In addition, the total incidence of adverse reaction in group A was 9.52%（4/42）, while group B was as high as 38.1%（16/42）, the difference between two groups had statistical significance（P〈0.05）. Compared with such indexes as postoperative white blood cells, C-reactive protein, ALT and AST of two groups, it was found that the improvements of each index in group A were much better than those in group B, P〈0.05. Conclusion For elderly patients with severe gallstone cholecystitis, they can be first given by PTGCD, and then underwent laparoscopic cholecystectomy,which can remarkably shorten the operation time, reduce the operation difficulty, shorten the postoperative recovery time, thus reduce postoperative hospital stay, and it can effectively reduce the incidence of postoperative related complications.