经皮经肝胆囊穿刺引流术序贯腹腔镜胆囊切除术治疗老年重症结石性胆囊炎患者的效果

Effects of percutaneous transhepatic gallbladder drainage sequential laparoscopic cholecystectomy in treatment of elderly patients with severe calculous cholecystitis

目的:观察经皮经肝胆囊穿刺引流术(PTGBD)序贯腹腔镜胆囊切除术(LC)治疗老年重症结石性胆囊炎患者的效果。方法:选取2016年10月至2021年1月该院收治的76例老年重症结石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观察组和对照组各38例。对照组行LC治疗,观察组行PTGBD序贯LC治疗,比较两组临床指标[抗感染时间、引流管留置时间、术后住院时间、体温恢复正常时间和白细胞计数(WBC)恢复正常时间]水平、术前和术后7 d疼痛程度[视觉模拟评分法(VAS)]评分、术前和术后3 d炎性因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平及并发症发生率。结果:观察组抗感染时间、引流管留置时间、术后住院时间、体温恢复正常时间和WBC恢复正常时间均短于对照组,差异有统计学意义(P<0.05);术后,观察组VAS评分,CRP、IL-6水平,以及并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:PTGBD序贯LC治疗老年重症结石性胆囊炎患者可改善临床指标水平,减轻术后疼痛和炎症反应,减少并发症,效果优于LC治疗。

Objective:To observe effects of percutaneous transhepatic gallbladder drainage(PTGBD)sequential laparoscopic cholecystectomy(LC)in treatment of elderly patients with severe calculous cholecystitis.Methods:A prospective study was conducted on 76 elderly patients with severe calculous cholecystitis admitted to the hospital from October 2016 to January 2021.They were divided into observation group and control group according to the random number table method,38 cases in each.The control group was treated with LC,while the observation group was treated with PTGBD sequential LC.The clinical indicator levels[anti-infection time,drainage tube dwelling time,postoperative hospitalization time,temperature and white blood cell count(WBC)recovery time],the pain degree[visual analog scale(VAS)]scores before and 7 days after the surgery,the inflammatory factor levels[C-reactive protein(CRP),interleukin-6(IL-6)]before and 3 days after the surgery,and the incidence of complications were compared between the two groups.Results:The antiinfection time,the drainage tube dwelling time,the postoperative hospitalization time,the body temperature and WBC recovery time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).After the surgery,the VAS score,the levels of CRP and IL-6,and the incidence of complications in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:PTGBD sequential LC can improve the levels of clinical indicators,reduce the postoperative pain and the inflammatory reaction,and reduce the complications in the elderly patients with severe calculous cholecystitis.Moreover,it is superior to the LC treatment.