腹腔镜穿刺置管引流术与腹腔镜切开置管引流术治疗肝脓肿患者疗效观察

Clinical observation of laparoscopic puncture drainage and laparoscopic incision drainage in treatment of patients with liver abscess

目的比较腹腔镜穿刺置管引流术与腹腔镜切开置管引流术治疗肝脓肿患者的疗效。方法2019年1月~2020年12月我院收治的63例肝脓肿患者,其中32例观察组接受腹腔镜穿刺置管引流术,另31例对照组接受腹腔镜切开置管引流术,术后随访3个月。采用ELISA法检测血清白细胞介素6(IL-6),采用胶体金法检测血清降钙素原(PCT)水平,采用双抗体夹心法检测血清C反应蛋白(CRP)水平。结果本研究观察组治愈率为96.9%,与对照组100.0%比,无显著性差异(P>0.05);观察组住院日和住院费用分别为(14.2±2.3)d和(1.3±0.2)万元,均显著少于或短于对照组【分别为(16.1±2.5)d和(1.6±0.3)万元,P<0.05】,观察组体温正常时间和脓腔消失时间分别为(2.3±0.4)d和(10.3±1.5)d,均显著长于对照组【分别为(1.7±0.4)d和(8.4±1.2)d,P<0.05】;在术前和术后7 d,观察组血清ALT、ALB、AST、GGT及CRP、PCT、IL-6水平和WBC计数比较均无显著性差异(P>0.05)。结论腹腔镜穿刺置管引流术与切开置管引流术治疗肝脓肿患者疗效相当,穿刺置管引流术有助于加快患者康复,是一种较为经济、简便的术式。

Objective The aim of this study was to compare the clinical efficacy of laparoscopic puncture drainage(LPD)and laparoscopic incision drainage(LID)in treatment of patients with bacterial liver abscess(BLA).Methods 63 patients with BLA were admitted to our hospital between January 2019 and December 2020,and were divided into observation(n=32),underwent LPD,and control group(n=31),underwent LID.They were all followed-up for 3 months after surgery.Serum interleukin 6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels were detected.Results All but one patients in the observation group who died from concomitant diabetes and pulmonary infection recovered in the two groups;the hospitalization stay and medical cost in the observation group were(14.2±2.3)d and(13.0±2.0)thousand yuan,both significantly shorter or lower than[(16.1±2.5)d and(16.0±3.0)thousand yuan,respectively,P<0.05],while the body temperature normal and hepatic abscess disappearance time were(2.3±0.4)d and(10.3±1.5)d,both significantly longer than[(1.7±0.4)d and(8.4±1.2)d,respectively,P<0.05]in the control;there were no significant differences respect to serum ALT,AST,GGT and albumin levels,as well as serum CRP,PCT,IL-6 levels or white blood cell counts between the two groups at presentation or after surgery(P>0.05).Conclusion The clinical efficacy of laparoscopic puncture drainage and laparoscopic incision drainage in dealing with patients with BLA is comparable,but the former is more beneficial to accelerate recovery of patients.