经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性重症胆囊炎的临床体会

Percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in the treatment of acute severe cholecystitis

目的:探讨经皮经肝胆囊穿刺引流后早期行腹腔镜胆囊切除术(LC)治疗急性重症胆囊炎的临床疗效。方法:选取2014年8月至2017年8月收治的42例急性重症胆囊炎患者,其中18例经皮胆囊穿刺引流一周后行LC(早期组),24例经皮胆囊穿刺引流延迟2～3个月后行LC(延期组)。对比两组手术时间、术中出血量、术后住院时间、中转开腹率、术后并发症及术后患者满意度。结果:两组手术时间、术后住院时间、中转开腹率、术后并发症差异无统计学意义(P>0.05)。早期组术后患者满意度优于延期组,术中出血量多于延期组,差异有统计学意义(P<0.05)。结论:经皮胆囊穿刺引流后早期行LC治疗急性重症胆囊炎安全、有效,患者满意度更高,值得临床推广。

Objective:To investigate the curative effect of percutaneous transhepatic gallbladder drainage combined with early laparoscopic cholecystectomy in the treatment of acute severe cholecystitis.Methods:A total of 42 patients with acute severe cholecystitis from Aug.2014 to Aug.2017 were divided into early group(18 patients who underwent laparoscopic cholecystectomy one week after percutaneous transhepatic gallbladder drainage)or delayed group(24 patients who underwent laparoscopic cholecystectomy 2-3 months after percutaneous transhepatic gallbladder drainage).The operative time,intraoperative blood loss,postoperative hospitalization time,rate of conversion to laparotomy,postoperative complications and patients satisfaction were compared between the two groups.Results:There was no significant difference between the two groups in operative time,postoperative hospitalization time,conversion rate or postoperative complications(P>0.05).The early group had better patients satisfaction but more bleeding during operation compared with the delayed group,the differences were statistically significant(P<0.05).Conclusions:The percutaneous transhepatic gallbladder drainage combined with early laparoscopic cholecystectomy is safe and effective in the treatment of acute severe cholecystitis with higher patients’satisfaction,so it is worth further clinical application.