PTGBD序贯LC与一期LC治疗中度急性胆囊炎效果的倾向性评分匹配分析

Efficacy of PTGBD followed by LC compared with one-stage LC for the treatment of moderate acute cholecystitis:A propensity score matching analysis

目的探讨经皮胆囊穿刺引流术(PTGBD)序贯腹腔镜胆囊切除术(LC)治疗中度急性胆囊炎的临床应用效果。方法回顾性分析2020年8月至2022年8月平煤神马医疗集团总医院收治的178例中度急性胆囊炎患者的临床资料,根据手术方法不同,分为一期LC组(n=133)和PTGBD序贯LC组(n=45)。采用倾向性评分匹配分析(PSM)方法对两组进行1∶1匹配,对比PSM前、后两组患者基线资料,PSM后两组患者各项指标。结果PTGBD序贯LC组45例患者均顺利完成手术,未出现出血、胆汁漏的现象。PSM前PTGBD序贯LC组患者年龄、胆囊壁厚度均比一期LC组高(P<0.05)。PSM后,每组各获得40例患者,两组基线资料具有可比性(P>0.05)。且PSM后,与一期LC组比较,PTGBD序贯LC组患者手术时间、术后住院时间短,术中出血量少,严重并发症发生率低,但住院费用高,差异均存在统计学意义(均P<0.05)。结论PTGBD序贯LC治疗中度急性胆囊炎患者可缩短手术时间,减少术中出血量,降低术后并发症的发生率,安全性较高,但可能会出现针道出血等并发症,加重经济负担,总体上来讲利大于弊,值得推广应用。

Objective To explore the clinical outcomes of percutaneous transhepatic gallbladder drainage(PTGBD)followed by laparoscopic cholecystectomy(LC)for the treatment of moderate acute cholecystitis.Methods The clinical data of 178 patients with moderate acute cholecystitis admitted to the General Hospital of Pingmeishenma Medical Group from Aug.2020 to Aug.2022 were retrospectively analyzed.The patients were divided into two groups based on the surgical methods:one-stage LC group(n=133)and PTGBD followed by LC group(n=45).Propensity score matching analysis(PSM)was used to match the two groups in a 1:1 ratio.Baseline data of patients before and after PSM were compared,and various indicators of patients in the two groups after PSM were also compared.Results All 45 patients in PTGBD followed by LC group successfully completed the operation without experiencing bleeding or bile leakage.The age and gallbladder wall thickness of patients in PTGBD followed by LC group before PSM were higher than those in one-stage LC group(P<0.05).After PSM,there were 40 patients in each group,and the baseline data of the two groups were similar(P>0.05).Post-PSM analysis revealed that the PTGBD followed by LC group had significantly shorter operation time and postoperative hospital stay,less intraoperative blood loss,lower incidence of severe complications,and higher hospitalization costs compared to the one-stage LC group(all P<0.05).Conclusion PTGBD followed by LC demonstrates efficacy in treating patients with moderate acute cholecystitis by decreasing operation time,minimizing intraoperative blood loss,and lowering the risk of postoperative complications while maintaining a high level of safety.However,the complications such as needle bleeding may occur and increase the economic burden.Despite these drawbacks,the benefits of this approach outweigh the disadvantages,making it a promising technique worthy of further implementation and exploration.