初期或后期经皮胆囊穿刺引流术与腹腔镜胆囊切除术序贯治疗急性胆囊炎患者疗效及安全性比较研究

Efficacy and safety of early and late sequential percutaneous trans-hepatic gallbladder drainage and laparoscopic cholecystectomy for patients with acute cholecystitis:a comparative study

目的比较初期与后期经皮经肝胆囊穿刺引流(PTGBD)与腹腔镜胆囊切除术(LC)序贯治疗急性胆囊炎患者的疗效与安全性。方法2019年3月~2020年6月我院收治的145例急性胆囊炎患者均接受PTGBD联合LC序贯治疗,其中70例在起病后7 d内(初期组),而另75例患者在起病7 d后(后期组)接受PTGBD,在其后择期行LC手术。采用ELISA法检测血清C反应蛋白、白介素-6和肿瘤坏死因子-α。结果在围LC手术期,后期组手术失血量为(26.8±9.3)mL,显著少于初期组【(46.2±16.3)mL,P<0.05】,手术时间为(67.3±9.2)min,显著短于初期组【(83.2±8.3)min,P<0.05】,肛门排气时间为(22.5±5.9)h,显著短于初期组【(28.2±6.2)h,P<0.05】,腹腔引流时间为(3.3±1.1)d,显著短于初期组【(6.3±1.3)d,P<0.05】;后期组血清谷草转氨酶和谷丙转氨酶水平显著低于初期组(P<0.05);后期组血清C反应蛋白、白介素-6和肿瘤坏死因子-α水平显著低于初期组(P<0.05);后期组术后胆漏、肺部感染等并发症发生率为5.3%,显著低于初期组的20.0%(P<0.05)。结论应用后期PTGBD联合LC序贯治疗急性胆囊炎患者疗效好,更安全,并发症更少。

Objective The aim of this study was to compare the efficacy and safety of early and late sequential percutaneous trans-hepatic gallbladder drainage(PTGBD)and laparoscopic cholecystectomy(LC)for the treatment of patients with acute cholecystitis.Methods 145 patients with acute cholecystitis were admitted to our hospital between March 2019 and June 2020,70 patients received PTGBD within seven days after onset of the disease and sequential LC(early PTGBD),and other 75 patients received PTGBD seven days after onset of the disease and sequential LC(lately PTGBD).Serum C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)levels were detected by ELISA.Results During LC,the blood loss in the lately PTGBD group was(26.8±9.3)mL,significantly less than[(46.12±16.3)mL,P<0.05]in the early PTGBD group,the operation time was(67.3±9.2)min,significantly shorter than[(83.2±8.3)min,P<0.05],the anal exhaust time was(22.5±5.9)h,significantly shorter than[(28.2±6.2)h,P<0.05],and the abdominal drainage time was(3.3±1.1)d,significantly shorter than[(6.6±1.3)d,P<0.05]in the early PTGBD group;serum aspartate aminotransferase and alanine aminotransferase levels in the lately PTGBD group were significantly lower than those in the early PTGBD group(P<0.05),and serum CRP,IL-6 and TNF-αlevels in the lately PTGBD group were significantly lower than those in the early PTGBD group(P<0.05);the incidence of postoperative complications,such as bile leak and infections in the lately PTGBD was 5.3%,significantly lower than 20.0%in the early PTGBD group(P<0.05).Conclusion The late PTGBD and sequential LC in dealing with patients with acute cholecystitis is efficacious and safe,with less post-operational complications.