引流术后腹腔镜下胆囊切除术治疗急性化脓坏疽性胆囊炎效果分析

Analysis about the effect of laparoscopic cholecystectomy after drainage on acute purulent gangrene cholecystitis

目的探讨引流术后腹腔镜下胆囊切除术治疗急性化脓坏疽性胆囊炎效果。方法回顾性分析2017年4月至2019年5月于本院经病理诊断确诊的急性化脓坏疽性胆囊炎患者92例,根据患者手术治疗方法分为对照组及观察组,两组患者各46例。对照组患者行腹腔镜下胆囊切除术,观察组患者先行胆囊穿刺置管造口引流后行腹腔镜下胆囊切除术。对比两组患者一般资料,治疗情况,病情恢复时间及术后并发症等。结果观察组患者手术时间、术后肛门排气时间、术后住院时间均短于对照组(P<0.05),观察组患者术中出血量少于对照组患者(P<0.05);对照组患者血流动力学恢复时间、凝血功能恢复时间及术后体温恢复时间均长于观察组(P<0.05);观察组患者总胆红素、谷丙转氨酶及谷草转氨酶水平低于对照组患者(P<0.05);观察组及对照组并发症发生率比较差异具有统计学意义(6.52%vs21.74%)(χ^2=4.839,P=0.036)。结论急性化脓坏疽性胆囊炎患者先行胆囊穿刺置管造口引流后再行腹腔镜胆囊切除术,可有效缩短患者手术时间,有利于患者术后恢复,减少患者术后并发症发生率。

Objective To investigate the effect of laparoscopic cholecystectomy for acute purulent gangrenous cholecystitis after drainage.Methods 92 patients with acute suppurative gangrenous cholecystitis diagnosed through pathological method in our hospital from April 2017 to May 2019 were retrospectively analyzed.All cases were divided into control group and observation group according to the surgical treatment method.There were 46 patients in each group.Patients in the control group underwent laparoscopic cholecystectomy,and patients in the observation group were treated with gallbladder puncture,catheterization and ostomy drainage followed by laparoscopic cholecystectomy.General information,treatment,recovery time and postoperative complications were compared between two groups.Results The operation time,postoperative anal exhaust time,and hospital stay of the observation group were shorter than those of the control group(P<0.05).The intraoperative blood loss in the observation group was less than that in the control group(P<0.05);The recovery time of hemodynamic,coagulation function and postoperative temperature in the control group were longer than those in the observation group(P<0.05);The total bilirubin,alanine aminotransferase and aspartate aminotransferase levels of the observation group were lower than those of the control group(P<0.05);The difference in the incidence of complications between the observation and control groups was statistically significant(6.52%vs21.74%)(χ^2=4.839,P=0.036).Conclusions Patients with acute purulent gangrenous cholecystitis undergo laparoscopic cholecystectomy after drainage of the gallbladder and catheter,which can effectively shorten the operation time of the patient,help the patient recover,and reduce the incidence of postoperative complications.