经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性重症胆囊炎的临床疗效分析

Clinical Efficacy Analysis of Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy in the Treatment of Acute Severe Cholecystitis

目的探讨急性重症胆囊炎患者给予经皮经肝胆囊穿刺引流+腹腔镜胆囊切除术的临床有效性。方法随机选取2020年2月—2023年12月安徽省池州市人民医院收治的90例急性重症胆囊炎患者为研究对象,根据随机数字表法分为对照组和观察组,每组45例。对照组给予腹腔镜胆囊切除术治疗,观察组联合经皮经肝胆囊穿刺引流治疗。分析两组患者的手术情况、炎症反应、并发症发生率。结果观察组的手术时间、术后肛门排气时间、住院时间、术中出血量优于对照组,差异有统计学意义(P均<0.05);观察组术后C反应蛋白为(58.13±15.65)mg/L、降钙素原为(1.77±0.35)ng/mL,低于对照组的(79.98±21.35)mg/L、(2.23±0.42)ng/mL,差异有统计学意义(t=5.537、5.644,P均<0.05);观察组的并发症发生率(胆总管损伤、胆瘘、感染、胆管损伤)为2.22%,低于对照组的22.22%,差异有统计学意义(χ^(2)=8.389,P<0.05)。结论采用经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术可改善临床症状,降低并发症、手术情况佳。

Objective To investigate the clinical efficacy of percutaneous transhepatic gallbladder drainage and laparo⁃scopic cholecystectomy in patients with acute severe cholecystitis.Methods A total of 90 patients with acute severe cholecystitis admitted to Chizhou People's Hospital of Anhui Province from February 2020 to December 2023 were randomly selected as the research objects.According to the random number table method,they were divided into con⁃trol group and observation group,with 45 cases in each group.The control group was treated with laparoscopic chole⁃cystectomy,and the observation group was combined with percutaneous transhepatic gallbladder puncture and drain⁃age surgery.The operation condition,inflammatory reaction and complication rate of the two groups were analyzed.Results The operation time,postoperative anal exhaust time,hospitalization time and intraoperative blood loss in the observation group were better than those in the control group,and the differences were statistically significant(all P<0.05).The postoperative C-reactive protein was(58.13±15.65)mg/L and procalcitonin was(1.77±0.35)ng/mL in the observation group,which were lower than(79.98±21.35)mg/L,(2.23±0.42)ng/mL in the control group,the differences were statistically significant(t=5.537,5.644,both P<0.05);the incidence of complications(common bile duct injury,biliary fistula,infection,bile duct injury)in the observation group was 2.22%,which was lower than 22.22%in the control group,and the difference was statistically significant(χ^(2)=8.389,P<0.05).Conclusion The use of percutaneous transhepatic gallbladder puncture drainage combined with laparoscopic cholecystectomy can improve clinical symp⁃toms,reduce complications,and achieve better surgical outcomes.