PTGD序贯LC治疗黄色肉芽肿性胆囊炎的临床疗效分析

Analysis of the clinical efficacy of PTGD sequential LC in the treatment of xanthogranulomatous cholecystitis

目的研究对比经皮经肝胆囊穿刺引流(PTGD)续贯腹腔镜胆囊切除术(LC)与一期行LC治疗黄色肉芽肿性胆囊炎(XGC)的安全性和临床疗效差异。方法回顾性分析2018年9月至2020年9月该院收治的36例XGC患者临床资料,根据不同的治疗方式分为PTGD组(n=21)和LC组(n=15)。其中PTGD组首先行PTGD,3个月后行LC;LC组则入院后一期行LC。观察两组患者围术期资料及手术时间、术中出血量、中转开腹率、手术并发症发生率。结果PTGD组手术时间、术中出血量低于LC组(P<0.05)。PTGD组21例均完成PTGD续贯LC,无中转开腹,而LC组有6例(40.0%)中转开腹,发生率显著高于PTGD组(P<0.05)。PTGD组腹部切口感染、胆管损伤发生率显著低于LC组(P<0.05);但两组术后胆漏、腹壁皮下气肿发生率差异无统计学意义(P>0.05)。结论PTGD续贯LC是一种安全有效治疗XGC的方式。

Objective To compare the safety and clinical efficacy of percutaneous transhepatic gallbladder drainage(PTGD)sequential laparoscopic cholecystectomy(LC)and one-stage LC in the treatment of xanthogranulomatous cholecystitis(XGC).Methods A retrospective study involving 36 patients with XGC who were admitted to this hospital from September 2018 to September 2020 was performed.The patients were divided into the PTGD group(n=21)and the LC group(n=15)according to the different treatment methods.The patients of the PTGD group were given PTGD first and LC three months later,and the patients of the LC group were given LC after admission.The perioperative data,operation time,intraoperative blood loss,conversion rate to open surgery and the incidence of surgical complications were observed.Results The operation time and blood loss in the PTGD group were lower than those in the LC group(P<0.05).All of the 21 cases in the PTGD group have completed the PTGD sequential LC without conversion to laparotomy,while 6 cases(40.0%)in the LC group were converted to laparotomy,which was significantly higher than that in the PTGD group(P<0.05).The incidence of abdominal incision infection and bile duct injury in the PTGD group were significantly less than those in the LC group(P<0.05),but there was no significant difference in the incidence of postoperative bile leakage and emphysema of abdominal wall between the two groups(P>0.05).Conclusion PTGD sequential LC is a safe and effective treatment for xanthogranulomatous cholecystitis.