经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性胆囊炎手术时机的选择

Timing of the laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in the treatment of acute cholecystitis

目的探讨经皮经肝胆囊穿刺引流（percutaneous transhepatic gallbladder drainage,PTGD）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy, LC）治疗急性胆囊炎（acute cholecystitis，AC）手术时机的选择。方法对比分析我院74例急性胆囊炎患者PTGD术后不同时间段行LC的临床资料，根据Lc治疗的时间间隔分为3组，第1组（31例）：4周内，第2组（22例）：4～8周。第3组（21例）：8周以上，对3组手术时间、术中出血、胆囊水肿程度、中转开腹比例、住院时间及总费用进行比较。结果第2组在手术时间、术中出血量、住院时间及总费用上优于第1组、第3组．差异有统计学意义（P〈0．05）。结论急性胆囊炎患者经PTGD治疗后4～8周内行Lc治疗能降低手术风险，减少住院时间及总住院费用。

Objective To evaluate appropriate timing of laparoseopie cholecystectomy （LC） after percutaneous transhepatic gallbladder drainage （PTGD） for the treatment of acute choleeystitis （AC）. Methods To compare the clinical data of 74 patients with acute cholecystitis who underwent laparoscopic cholecystectomy at different time after PTGD, Including the degree of gallbladder inflammation, operation time,intraoperative blood loss, the rate of conversion to laparotomy, length of stay and total cost. 74 cases were divided into 3 groups, group 1 （ n = 31 ）, operated within 4 w, group 2 （ n = 22 ）, between 4 and 8 w, group 3 （n = 21 ）, after 8 w. Results Group 2 was better than group 1 and group 3 in operation time, blood loss, length of stay and total cost, the difference was statistically significant （P 〈 0. 05 ）. Conclusion Laparoscopic cholecystectomy performed after 4 - 8 weeks PTGD is the best time in terms of less risk of operation, shorter hospital stay, lower cost, and better quality of life.