超声引导下经皮肝胆囊穿刺引流术联合腹腔镜胆囊切除术治疗高龄高危急性化脓性胆囊炎效果观察

Observation on the Effect of Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy in the Treatment of Elderly Patients with High-Risk Acute Suppurative Cholecystitis

目的:观察超声引导下经皮肝胆囊穿刺引流术联合腹腔镜胆囊切除术治疗高龄高危急性化脓性胆囊炎效果。方法:选择2018年1月~2019年8月本院收治的58例高危急性化脓性胆囊炎的高龄患者,按照治疗方法不同将患者分为两组。对照组入院后经抗感染治疗及对症治疗,3d后行腹腔镜胆囊切除术。观察组患者则在入院后行超声引导下经皮肝胆囊穿刺引流,而后择期行腹腔镜胆囊切除术。结果:观察组患者的手术时间和术后住院时间短,术中出血量更少,组间各项比较均有统计学意义,P<0.05。观察组29例患者中有1例中转开腹手术,发生1例切口血肿,对照组29例患者中有3例中转开腹手术,发生切口感染、切口血肿各2例,胆漏、不完全肠梗阻各1例;组间中转开腹率和并发症发生率均有统计学意义,P<0.05。结论:对高危急性化脓性胆囊炎的高龄患者使用超声引导下经皮肝胆囊穿刺引流术联合腹腔镜胆囊切除术治疗安全有效,并且能降低中转开腹率,并发症少。

Objective:To observe the effect of ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in the treatment of high-risk acute suppurative cholecystitis in elderly patients.Methods:58 elderly patients with high-risk acute suppurative cholecystitis admitted to our hospital from January 2018 to August 2019 were selected,and the patients were divided into two groups according to different treatment methods.In the control group,patients received anti-infective and symptomatic treatment after admission,and laparoscopic cholecystectomy was performed 3 days later.While patients in the observation group underwent ultrasound-guided percutaneous transhepatic gallbladder drainage after admission,and then underwent elective laparoscopic cholecystectomy.Results:Patients in the observation group had shorter operation time and postoperative hospital stay,and had less intraoperative blood loss(P<0.05).Among 29 patients in the observation group,one case was converted to laparotomy,one case appeared incisional seroma.In the control group,three out of the 29 patients were converted to laparotomy,two cases appeared incisional infection and two cases appeared incisional seroma,one case developed bile leakage and one case developed incomplete intestinal obstruction;the conversion rate and complication incidence showed statistically significant difference between groups(P<0.05).Conclusion:For elderly patients with high-risk acute suppurative cholecystitis,the treatment of ultrasoundguided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy is safe and effective,it can reduce the rate of conversion to laparotomy and induce few complications.