探讨急性重症胆囊炎行微创治疗手术时机的研究

To investigate the time of minimally invasive operation for acute severe cholecystitis

目的:探讨急性重症胆囊炎行微创治疗手术时机的研究。方法:选取2018年1月至2021年12月在我院就诊的急性重症胆囊炎患者55例为研究对象,根据患者行腹腔镜胆囊切除术(LC)手术时机的不同分为LC组25例和PTGD联合LC组30例。LC组均行LC,PTGD联合LC组先行超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)后5至8周再行LC。比较两组患者相关临床指标。结果:两组患者年龄、性别、体质量指数(BMI)、麻醉医师协会(ASA)分级方面比较差异均无统计学意义(P>0.05),LC组术前经腹部彩超检测胆囊壁厚度大于PTGD联合LC组(P<0.001)。与LC组相比,PTGD联合LC组行LC手术时间较短,术中出血量及术中胆囊三角粘连例数较少,白细胞及体温恢复正常时间、拔除腹腔引流管时间及术后首次排气时间较早(P<0.05);PTGD联合LC组行LC术后谷丙转氨酶、γ-谷氨酰基转移酶、C反应蛋白、降钙素原及术后并发症总发生率均低于LC组,术后前白蛋白及超氧化物歧化酶水平均高于LC组(均P<0.001)。LC组和PTGD联合LC组病人中转开腹发生率比0.00%:3.33%,组间比较无统计学差异(P>0.05)。结论:对于急性重症胆囊炎病人,超声引导下PTGD后行LC,能减轻术中粘连程度,促进术后早期快速恢复,减轻术前、术中胆囊的炎症反应,改善肝功能状态,也能够降低术后并发症发生率,是一种安全、可行的治疗措施。

Objective:To investigate the timing of minimally invasive surgery for acute severe cholecystitis.Methods:Fifty five patients with acute severe cholecystitis who visited our hospital from January 2018 to December 2021 were selected as the study subjects,and the patients were divided into LC group(25 cases)and PTGD combined with LC group(30 cases)according to the different surgical timing of laparoscopic cholecystectomy(LC).The LC group all underwent LC,and the PTGD combined with LC group received LC before 5-8 weeks after initial ultrasound-guided percutaneous transhepatic cholecystocentesis catheter drainage(PTGD).Patient related clinical indicators were compared between the two groups.Results:there were no significant differences in age,gender,body mass index(BMI),and society of anesthesiologists(ASA)grade between the two groups(P>0.05),and the gallbladder wall thickness measured by preoperative transabdominal color ultrasound in the LC group was greater than that in the PTGD combined with LC group(P<0.001).Compared with the LC group,the PTGD combined with LC group had a shorter operation time,less intraoperative blood loss and intraoperative adhesion of the gallbladder trigone,a shorter time for the return of white blood cells and body temperature to normal,the time for the removal of abdominal drainage tube and the time for the first postoperative flatus(P<0.05);PTGD combined with LC group had postoperative alanine transaminaseγ-The overall incidences of glutamyltransferase,C-reactive protein,procalcitonin,and postoperative complications were lower in the LC group,and the postoperative prealbumin and superoxide dismutase levels were higher in the LC group(all P<0.001).The incidence ratio of conversion to open was 0.00%:3.33%in LC group and PTGD combined with LC group patients,and there was no statistical difference between groups(P>0.05).Conclusions:in patients with acute severe cholecystitis,LC performed after ultrasound-guided PTGD is a safe and feasible treatment to relieve the degree of intraoperative adhesion,promote early and rapid postoperative recovery,attenuate the inflammatory response of the gallbladder before and during surgery,improve liver function status,and also reduce the incidence of postoperative complications.