探究经皮经肝胆囊穿刺置管引流术后腹腔镜胆囊切除术治疗老年急性化脓性胆囊炎患者的临床疗效

To explore the clinical efficacy of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in the treatment of elderly patients with acute suppurative cholecystitis

目的探究经皮经肝胆囊穿刺置管引流术(PTGD)后腹腔镜胆囊切除术治疗老年急性化脓性胆囊炎患者的临床疗效。方法选取2017年2月至2020年10月本院收治的80例老年急性化脓性胆囊炎患者作为研究对象,按照随机数字表法分为对照组与观察组,每组40例。对照组采用腹腔镜胆囊切除术治疗,观察组在对照组基础上于术前给予PTGD处理,比较两组手术时间、手术出血量、症状改善时间、住院时间、并发症发生率、手术前后白细胞计数及血清总胆红素水平。结果两组手术时间比较差异无统计学意义;观察组手术出血量少于对照组,症状改善时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术前,两组白细胞计数、血清总胆红素水平比较差异无统计学意义;术后,两组白细胞计数少于术前,血清总胆红素水平低于术前,且观察组白细胞计数少于对照组,血清总胆红素水平低于对照组,差异有统计学意义(P<0.05)。观察组发生率为5.00%,低于对照组的22.20%,差异有统计学意义(P<0.05)。结论PTGD后腹腔镜胆囊切除术治疗老年急性化脓性胆囊炎疗效显著,患者出血少、恢复快,安全性高,且能明显改善白细胞计数与血清总胆红素水平,值得临床推广应用。

Objective To investigate the clinical efficacy of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage(PTGD)in the treatment of elderly patients with acute suppurative cholecystitis.Methods 80 elderly patients with acute suppurative cholecystitis treated in our hospital from February 2017 to October 2020 were selected as the research subjects,and they were randomly divided into control group and observation group according to the random number table method,with 40 cases in each group.The control group was treated with laparoscopic cholecystectomy,and the observation group was treated with PTGD before operation on the basis of the control group.The operation time,the amount of bleeding,the time of symptom improvement,the length of hospital stay,the incidence of complications,the white blood cell count before and after operation and the serum total bilirubin level were compared between the two groups.Results There was no significant difference in opera-tion time between the two groups;the amount of bleeding in the observation group was less than that in the control group,and the time of symptom improvement and the length of hospital stay were shorter than those in the control group(P<0.05).Before operation,there was no significant differ-ence in white blood cell count and serum total bilirubin level between the two groups;after operation,the white blood cell count in the two groups was lower than that before operation,the serum total bilirubin level was lower than that before operation,and the white blood cell count in the obser-vation group was lower than that in the control group,and the serum total bilirubin level was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence rate in the observation group was 5.00%,lower than 22.20%in the control group(P<0.05).Conclusion Laparoscopic cholecystectomy after PTGD is effective in the treatment of acute suppurative cholecystitis in the elderly,with less bleed-ing,rapid recovery,high safety,and can significantly improve the white blood cell count and serum total bilirubin level,which is worthy of clinical application.