胆囊切除与胆囊穿刺引流治疗急性胆囊炎的对比分析

The Comparative Analysis of Cholecystectomy and Gallbladder Puncture Drainage in the Treatment of Acute Cholecystitis

目的研究对比72小时后急性胆囊炎行腹腔镜胆囊切除(LC)与经皮经肝胆囊穿刺引流(PTGD)的临床疗效。方法回顾性分析2014年12月—2016年12月PTGD治疗72小时急性胆囊炎33例为对照组;2017年1月-2019年1月LC治疗72小时后急性胆囊炎35例为研究组。结果研究组无术中中转开腹、胆道损伤及术后胆漏。对照组1例穿刺后严重胆漏急诊行腹腔镜胆囊切除术,其余顺利完成穿刺引流及带管出院,2~4月内行二期LC。随访3~36月研究组无胆管狭窄及残余胆囊疾病发生;对照组1例术后2月脱管立即行LC研究组患者年龄、性别、发病时间、术前合并症、术后胃肠功能恢复、住院时间与对照组差异无统计学意义(P>0.05)。结论LC治疗72小时后急性胆囊炎是安全可靠的,与PTGD相比减少胆漏及术后脱管的风险,避免二次手术对患者的打击。

Objective To compare the clinical effect of laparoscopic cholecystectomy(LC)and percutaneous transhepatic gallbladder drainage(PTGD)in cases of over-72-hour acute cholecystitis.Methods From December 2014 to December 2016,a retrospective analysis was made on 33 cases of over-72-hour acute cholecystitis treated by PTGD as the control group,and 35 cases of over-72-hour acute cholecystitis treated by LC from January 2017 to January 2019 as the experimental group.Results There were no intraoperative conversion to laparotomy,bile duct injury and postoperative bile leakage in the experimental group.In the control group,1 case of severe bile leakage was treated with laparoscopic cholecystectomy in emergency,the rest of them successfully completed the puncture drainage and discharge with a tube,and the second stage LC was performed within 2~4 months.During the follow-up period of 3-36 months,there was no biliary stricture or residual gallbladder disease in the experimental group,and LC was performed in the control group in 2 months after operation.There was no significant difference in age,gender,onset time,preoperative complications,postoperative recovery of gastrointestinal function and hospitalization time between the experimental group and the control group(P>0.05).Conclusion LC is safe and reliable in the treatment of acute cholecystitis over 72 hours.Compared with PTGD,LC can reduce the risk of bile leakage and postoperative catheter removal,and avoid the impact of secondary operation on patients.