经皮经肝胆囊穿刺引流治疗高龄坏疽性胆囊炎的临床价值

Clinical value of percutaneous tranhepatic cholecystectomy and drainage in the treatment of senile gangrenous cholecystitis

目的:探讨经皮经肝胆囊穿刺引流术(Percutaneous transhepatic gallbladder drainage,PTGBD)治疗高龄坏疽性胆囊炎的临床价值。方法:选取2016年1月-2018年1月在我院就诊的40例高龄急性坏疽性胆囊炎患者,将其随机分为对照组和观察组,每组患者各20例,对照组直接行腹腔镜胆囊切除术治疗,观察组先予以经皮经肝胆囊穿刺引流术,然后待病情稳定后再择期行腹腔镜胆囊切除术治疗,观察比较两组手术时间、术中出血量、凝血功能恢复时间、住院时间、白细胞及体温恢复时间及并发症发生情况。结果:观察组手术时间、术中出血量、凝血功能恢复时间、住院时间、白细胞及体温恢复正常所需要的时间均显著低于对照组(P<0.05),差异有统计学意义;观察组腹腔出血、多器官功能衰竭和胆汁漏等并发症发生率显著低于对照组(P<0.05),肝脏损伤和气胸发生率在两组之间差异无统计学意义(P>0.05)。结论:经皮经肝胆囊穿刺引流术可显著缓解高龄坏疽性胆囊炎患者的临床症状,为后期在患者一般情况改善后实施胆囊切除术创造有利条件,避免施行急诊胆囊摘除手术从而降低患者的各种术中及术后并发症,值得在临床中推广应用。

Objective:To explore the clinical value of percutaneous transhepatic gallbladder drainage(PTGBD)in the treatment of senile gangrenous cholecystitis.Methods:40 elderly patients with acute gangrene cholecystitis admitted to our hospital from January 2016 to January 2018 were selected and randomly divided into the control group and the observation group,with 20 patients in each group.The control group was directly treated with laparoscopic cholecystectomy,and the observation group was first treated with percutaneous transhepatic cholecystectomy and drainage of the hepatic cholecystectomy,laparoscopic cholecystectomy was performed at a later stage after the patient’s condition was stabilized.The operative time,intraoperative blood loss,recovery time of coagulation function,hospitalization time,recovery time of white blood cells and body temperature and complications of the two groups were observed and compared.Results:The operation time,intraoperative blood loss,the recovery time of coagulation function,hospitalization time,the time required for the recovery of white blood cells and body temperature in the observation group were significantly lower than those in the control group(P<0.05),the difference was statistically significant;The incidence of complications such as abdominal bleeding,multiorgan failure and bile leakage in the observation group was significantly lower than that in the control group(P<0.05),and there was no statistical difference between the two groups in the incidence of liver injury and pneumothorax(P>0.05).Conclusion:Percutaneous transhepatic gallbladder puncture and drainage could significantly alleviate the clinical symptoms of elderly patients with gangrenous cholecystitis,create favorable conditions for the implementation of cholecystectomy after the improvement of the general situation of patients in the later stage,avoid the implementation of emergency cholecystectomy so as to reduce all kinds of intraoperative and postoperative complications of patients,which was worth popularizing in clinical application.