进展期急性胆囊炎的手术时机

Surgical timing for advanced acute cholecystitis

目的探讨进展期急性胆囊炎(AAC)患者经皮经肝胆囊穿刺引流术(PTGBD)后行腹腔镜胆囊切除术(LC)的手术时机。方法回顾分析某院近3年收治的AAC患者的临床资料(共242例),其中85例患者于PTGBD后接受LC治疗,85例患者中54例患者于PTGBD后5~12 d内接受LC(平均时间7 d),为早期手术组;31例患者于66~100 d内行LC(平均时间79 d),为延期手术组。比较两组患者手术操作时间、术中出血量、中转开腹率、手术并发症发生率、人均住院日、人均住院费用、PTGBD引流管相关并发症的差异。结果早期手术组患者的手术操作时间(46.9±9.3)min较延期手术组(75.6±9.0)min短(P<0.01);早期手术组患者的术中出血量(21.1±9.3)mL较延期手术组(12.5±6.4)mL多(P<0.01);两组患者均无中转开腹情况;早期手术组患者无手术并发症,延期手术组术后胆漏1例、术后腹腔出血1例(P=0.13);早期手术组患者的人均住院日(13.6±2.7)d短于延期手术组的(16.7±2.7)d(P<0.01);早期手术组人均住院费用为(2.6±0.49)万元,明显少于延期手术组的(3.2±0.65)万元(P<0.01);早期手术组无PTGBD引流管相关并发症,延期手术组脱管3例,堵塞1例(P=0.016)。结论AAC患者PTGBD后早期行LC安全可行,符合快速康复外科理念。

Objective To investigate the surgical timing of laparoscopic cholecystectomy(LC)after percutaneous transhepatic gallbladder drainage(PTGBD)in patients with advanced acute cholecystitis(AAC).Methods The clinical data of AAC patients admitted to a hospital in recent 3 years(242 cases in total)were retrospectively analyzed.Among them,85 patients received LC treatment after PTGBD,and 54 out of the 85 patients received LC within 5 to 12 days after PTGBD(mean time with 7 days),which was the early operation group.Thirty-one patients underwent LC within 66 to 100 days(mean time with 79 days),which was the delayed operation group.The differences in operation time,intraoperative blood loss,rate of transfer to laparotomy,incidence of surgical complications,per capita hospital stay,per capita hospital expenses,and complications related to PTGBD drainage tube were compared between the two groups.Results The surgical time of patients in the early operation group was(46.9±9.3)min,shorter than(75.6±9.0)min in the delayed operation group(P<0.01).The intraoperative blood loss of(21.1±9.3)mL in the early operation group was higher than(12.5±6.4)mL in the delayed operation group(P<0.01).Patients in both groups did not switch to laparotomy.There was no surgical complication in the early operation group,while there was 1 case of postoperative bile leakage and 1 case of postoperative abdominal hemorrhage in the delayed operation group(P=0.13).The average length of hospitalization of patients in the early operation group was(13.6±2.7)d,shorter than(16.7±2.7)d in the delayed operation group(P<0.01).The average hospitalization cost of the early operation group was(26±4.9)thousand yuan,which was significantly less than(32±6.5)thousand yuan of the delayed operation group(P<0.01).There were no complications related to PTGBD drainage tube in the early operation group,while there were 3 cases of tube detachment and 1 case of blockage in the delayed operation group(P=0.016).Conclusion Early LC after PTGBD in AAC patients is safe and feasible,which conforms to the concept of rapid rehabilitation surgery.