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

Clinical effect of percutaneous transhepatic cholecystostomy in the treatment of severe cholecystitis in the elderly

目的探析老年重症结石性胆囊炎进行经皮经胆囊穿刺造瘘术疗法的临床效果观察。方法临床选择2015年3月~2017年4月本院收治的老年重症结石性胆囊炎患者50例,根据随机数字表法分为对照组和观察组,每组25例,观察组进行经皮经胆囊穿刺造瘘术,对照组进行常规胆囊造瘘术,比较两组的住院时间、术中出血、手术耗时等指标;比较两组的凝血功能恢复时间、白细胞恢复时间、体温恢复时间、休克纠正时间等临床指标;比较两组的胆瘘、术后多器官衰竭、肝脏损伤、气胸、肠穿孔等并发症发生情况。结果观察组的术中出血、住院时间、手术耗时等指标显著低于对照组,差异有统计学意义(P<0.05);观察组的凝血功能恢复时间、白细胞恢复时间、体温恢复时间、休克纠正时间等指标显著优于对照组,差异有统计学意义(P<0.05);观察组胆瘘、术后多器官衰竭、肝脏损伤、气胸、肠穿孔等术后并发症发生率为8.0%,对照组胆瘘、术后多器官衰竭、肝脏损伤、气胸、肠穿孔等术后并发症发生率为32.0%,两组比较差异有统计学意义(P<0.05)。结论老年重症结石性胆囊炎患者进行经皮经肝胆囊穿刺造瘘术,手术时间缩短,并发症降低,术后迅速康复,临床效果确切,值得临床推广。

Objective To investigate the clinical effect of percutaneous transhepatic cholecystostomy in the treatment of elderly patients with severe calculous cholecystitis. Methods From March 2015 to April 2017,50 elderly patients with severe calculous cholecystitis were randomly divided into control group and observation group with 25 cases in each group.The observation group was treated by percutaneous transhepatic cholecystostomy,while the control group was treated with routine cholecystectomy.The duration of hospitalization,intraoperative bleeding and operation time were compared between the two groups,and the recovery time of coagulation function,leukocyte,body temperature and shock correction were compared between the two groups.The complications of biliary fistula,multiple organ failure,liver injury,pneumothorax and intestinal perforation were compared between the two groups. Results The indexes of intraoperative bleeding,hospital stay and operation time in the observation group were significantly lower than those in the control group(P < 0.05).The recovery time of coagulation function,white blood cell,body temperature and shock correction in the observation group were significantly better than those in the control group(P < 0.05).The incidence of postoperative complications such as biliary fistula,postoperative multiple organ failure,liver injury,pneumothorax and intestinal perforation in the observation group was 8.0%,in the control group,the incidence of postoperative complications such as biliary fistula,multiple organ failure,liver injury,pneumothorax and intestinal perforation was 32.0%,there was significant difference between the two groups(P < 0.05). Conclusion Percutaneous transhepatic cholecystectomy in elderly patients with severe calculous cholecystitis can shorten the operation time,reduce complications and can recover rapidly after operation and it has the exact clinical effect and is worthy of clinical popularization.