急性胆囊炎穿刺引流术后腹腔镜胆囊切除术的时机探讨

Timing of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis

目的:探讨急性胆囊炎穿刺引流术后行腹腔镜胆囊切除术(LC)的最佳时机。方法:采用前瞻性随机对照的方法,选取2018年10月至2021年9月经皮经肝胆囊引流术后行LC的106例患者,后剔除4例,共纳入102例,其中4~6周内施术为早期腹腔镜胆囊切除术(ELC)组(n=52),7~8周为晚期腹腔镜胆囊切除术(DLC)组(n=50)。观察两组手术时间、失血量、胆囊部分切除率、中转开腹率、并发症发生率、术后排气时间、术后进食时间、引流管拔除时间、住院时间、住院治疗费用、术后疼痛评分及手术前后36条简明健康状况调查表(SF-36)评分情况。结果:102例患者中男29例,女73例,中位年龄69岁,两组患者性别、年龄、BMI、ASA分级、体力状态、术前合并症、Ⅱ/Ⅲ级急性胆囊炎比例差异无统计学意义(P>0.05)。DLC组手术时间长于ELC组;ELC组失血量多于DLC组,治疗费用低于DLC组;差异有统计学意义(P<0.05);两组中转率、并发症发生率、胆囊部分切除率、术后排气时间、术后进食时间、引流管拔除时间、住院时间、术后疼痛评分差异无统计学意义(P>0.05);术前ELC组SF-36评分优于DLC组,差异有统计学意义(P<0.05),术后两组SF-36评分差异无统计学意义(P>0.05)。结论:急性胆囊炎经皮经肝胆囊引流术后行LC的手术时机应在4~6周,可缩短手术时间,提高患者生活质量,减轻负担。

Objective:To explore the best timing of laparoscopic cholecystectomy(LC)after percutaneous transhepatic g allbladder drainage for acute cholecystitis.Methods:A prospective randomized controlled study was conducted.106 patients who u nderwent LC after percutaneous transhepatic gallbladder drainage were selected from Oct.2018 to Sep.2021,and 4 cases were e xcluded.A total of 102 cases were enrolled,including 52 cases in the early laparoscopic cholecystectomy(ELC)group(LC in 4-6 weeks after drainage)and 50 cases in the delayed laparoscopic cholecystectomy(DLC)group(LC in 7-8 weeks after drainage).The operation time,blood loss,partial cholecystectomy rate,rate of conversion to open operation,incidence of complications,postoperative exhaust time,postoperative eating time,drainage tube removal time,hospital stay,hospitalization expenses,postoperative pain score,preoperative and postoperative SF-36 score in the two groups were observed and analyzed.Results:There were 29 males and 73 females with a median age of 69 years.There was no significant difference between the two groups in gender,age,BMI,ASA grade,physical status,preoperative complications and the ratio of gradeⅡ/Ⅲacute cholecystitis(P>0.05).The operation time in the DLC group was longer than that in the ELC group.Blood loss in the ELC group was more than that in the DLC group.The treatment cost in the DLC group was higher than that in the ELC group(P<0.05).There was no significant difference in rate of conversion to l aparotomy,complication incidence,the rate of partial cholecystectomy,postoperative exhaust time,postoperative eating time,drainage tube extraction time,hospital stay and postoperative pain score between the two groups(P>0.05).The SF-36 score of the ELC group was significantly better than that of the DLC group before the operation(P<0.05),and there was no significant difference in SF-36 score between the two groups after operation(P>0.05).Conclusions:LC after percutaneous transhepatic gallbladder drainage for acute cholecystitis should be performed within 4-6 weeks,it can reduce the operation time,improve the quality of life and reduce the burden of patients.