比较B超引导下经皮经肝胆囊引流和经皮经腹膜胆囊引流对后续腹腔镜胆囊切除术(LC)的影响

Compare the Effect of Percutaneous Transhepatic Gallbladder Drainage and Percutaneous Transperitoneal Gallbladder Drainage Guided by B-ultrasound on Subsequent Laparoscopic Cholecystectomy(LC)

目的比较与导管放置路径相关的B超引导的经皮胆囊造口术(PC)对后续腹腔镜胆囊切除术(LC)的影响。方法选取在PC后接受预定LC的140例急性结石性胆囊炎患者,依据双盲法分为观察组与对照组各70例。观察组为经皮经肝胆囊引流(PHGD)后接受预定LC的患者,对照组为经皮经腹膜胆囊引流(PPGD)后接受预定LC的患者。观察两组穿刺期间疼痛评分、穿刺后12h疼痛评分、PC后24h内发热、寒战、PC部位局部出血、术后轻度粘连人数,术后重度粘连人数、腹腔镜胆囊造口术的手术持续时间、术中出血量、严重粘连率和住院时间。结果全部140例患者均行穿刺引流且均获随访,观察组的穿刺期间疼痛评分、穿刺后12h疼痛评分、PC后24h内发热、寒战、PC部位局部出血均优于对照组,差异有统计学意义(P<0.05)。观察组术后轻度粘连36例,术后重度粘连34例与对照组术后轻度粘连48例,术后重度粘连22例相比有统计学意义(P<0.05)。观察组腹腔镜胆囊造口术的手术持续时间、术中出血量、严重粘连率和住院时间均优于对照组腹腔镜胆囊造口术,差异有统计学意义(P<0.05)。结论B超引导下的PHGD接受LC优于PPGD接受LC治疗急性结石性胆囊炎,具有手术时间短、术中出血少、住院时间短等优点,值得临床推广。

Objective Compare the effect of ultrasound-guided percutaneous cholecystostomy(PC)related to catheter placement path on subsequent laparoscopic cholecystectomy(LC).Methods A total of 140 patients with acute calculous cholecystitis who received scheduled LC after PCwere selected and divided into observation group and control group according to the double-blind method.The observation group was patients who received a predetermined LC after percutaneous transhepatic gallbladder drainage(PHGD),and the control group was a patient who received predetermined LC after percutaneous transperitoneal gallbladder drainage(PPGD).Results All 140 patients underwent puncture and drainage and were followed up.The pain score during puncture,pain score 12h after puncture,fever,chills and local hemorrhage at the PC site in the observation group were better than those of the control group within 24 hours after puncture,and the differences were statistically significant.(P<0.05).All 140 patients underwent laparoscopic cholecystostomy and were followed up.Among them,the observation group had 36 cases of mild postoperative adhesions and 34 had severe postoperative adhesions;the control group had 48 cases of mild postoperative adhesions and 22 had severe postoperative adhesions.example.The operation duration,intraoperative blood loss,severe adhesion rate and hospital stay of the observation group were better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion PHGD guided by B-ultrasound is superior to PPGD,followed by LC,which is used for the treatment of acute calculous cholecystitis.It has the advantages of short operation time,less intraoperative bleeding,and short hospital stay.It is worthy of clinical promotion.