PTGBA术与PTGBD术治疗老年重症急性胆囊炎患者的效果比较

Comparison of effects of PTGBA and PTGBD in treatment of elderly patients with severe acute cholecystitis

目的:比较经皮经肝胆囊穿刺抽吸术(PTGBA)与经皮经肝胆囊穿刺引流术(PTGBD)治疗老年重症急性胆囊炎患者的效果。方法:选取2019年2月至2021年2月该院收治的98例老年重症急性胆囊炎患者进行前瞻性研究,按照随机数字表法将其分为研究组(n=50)与对照组(n=48)。对照组采用PTGBD术治疗,研究组采用PTGBA术治疗,比较两组围术期相关指标水平、手术前后肝功能指标[总胆红素(TBIL)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]水平、免疫功能指标[淋巴细胞比例、单核细胞绝对值]水平、肿瘤坏死因子-α(TNF-α)水平和并发症发生率。结果:两组术中出血量、操作成功率比较,差异均无统计学意义(P>0.05);研究组手术时间长于对照组,差异有统计学意义(P<0.05);术后1周,两组TBIL、ALP、ALT、AST水平均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);两组淋巴细胞比例水平均高于术前,且研究组高于对照组,两组单核细胞绝对值水平和TNF-α水平均低于对照组,且研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为4.00%,低于对照组的18.75%,差异有统计学意义(P<0.05)。结论:PTGBA术治疗老年重症急性胆囊炎患者可改善免疫功能指标水平,降低肝功能指标水平、TNF-α水平和并发症发生率,其效果优于PTGBD术治疗,但需延长手术时间。

Objective:To compare effects of percutaneous transhepatic gallbladder aspiration(PTGBA)and percutaneous transhepatic gallbladder drainage(PTGBD)in treatment of elderly patients with severe acute cholecystitis.Methods:A prospective study was conducted on 98 elderly patients with severe acute cholecystitis admitted to the hospital from February 2019 to February 2021.They were divided into study group(n=50)and control group(n=48)according to the random number table method.The control group was treated with PTGBD,while the study group was treated with PTGBA.The levels of perioperative related indicators,the liver function indicator levels[total bilirubin(TBIL),alkaline phosphatase(ALP),alanine aminotransferase(ALT),aspartate aminotransferase(AST)],the immune function indicator levels[lymphocyte ratio,monocyte absolute value],the tumor necrosis factor-α(TNF-α)levels,and incidence of complications were compared between the two groups before and after the surgery.Results:There were no significant differences in the intraoperative blood loss and the operation success rate between the two groups(P>0.05).The operation time of the study group was longer than that of the control group,and the difference was statistically significant(P<0.05).One week after the surgery,the levels of TBIL,ALP,ALT and AST in the two groups were lower than those before the surgery,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The lymphocyte ratios in the two groups were higher than those before the surgery,and that in the study group was higher than that in the control group;the monocyte absolute value and the TNF-αlevel in the two groups were lower than those before the surgery,and those in the study group were lower than the control group;and,the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 4.00%,which was lower than 18.75%in the control group,the difference was statistically significant(P<0.05).Conclusions:PTGBA in the treatment of the elderly patients with severe acute cholecystitis can improve the levels of immune function indicators and reduce the levels of liver function indicators,the TNF-αlevel and the incidence of complications.Moreover,it is superior to PTGBD,but the operation time should be prolonged.