急性结石性胆囊炎患者经皮经肝胆囊穿刺引流后腹腔镜胆囊切除术时间对最终疗效的影响

Effect of time of laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage on fi nal outcome

目的研究急性结石性胆囊炎(acute calculous cholecystitis,ACC)患者经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)后腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)实施时间对最终疗效的影响。方法回顾性分析北京市通州区中医医院2021年1月至2022年12月收治的80例ACC患者的临床资料,所有患者均于PTGD后行LC治疗。根据PTGD后行LC的间隔时间分组,>60d为试验组、≤60d为对照组,比较两组患者手术疗效。结果试验组患者LC前胆囊壁厚度较对照组薄,行LC手术时间、术后住院时间较对照组短,LC术中出血量少于对照组,中转开腹率及术后并发症发生率较对照组低,差异均有显著性(P<0.05)。试验组患者LC后促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)水平较对照组低,差异有显著性(P<0.05)。结论PTGD术后60d后再行LC治疗ACC患者有更好的手术表现,缩短手术时间等的同时还能提高术中及术后安全性,减轻患者应激反应。

Objective To study the effect of time of laparoscopic cholecystectomy(LC)performed after percutaneous transhepatic gallbladder drainage(PTGD)in patients with acute calculous cholecystitis(ACC)on the fi nal outcome.Method Retrospective analysis of clinical data of 80 ACC patients admitted to Tongzhou District Traditional Chinese Medicine Hospital in Beijing from January 2021 to December 2022,all patients underwent LC treatment after PTGD.According to the interval time of LC after PTGD,patients were divided into experimental group(>60 days)and control group(≤60 days),and the surgical effi cacy of the two groups was compared.Result The thickness of the gallbladder wall before LC in the experimental group was thinner than that in the control group,and the time for LC surgery and postoperative hospitalization were shorter than those in the control group.The amount of bleeding during LC surgery was less than that in the control group,and the rate of conversion to open surgery and postoperative complications were lower than those in the control group,with significant diff erences(P<0.05).The levels of adrenocorticotropic hormone(ACTH)in the experimental group after LC were signifi cantly lower than those in the control group(P<0.05).Conclusion Patients with ACC treated with LC 60 d after PTGD had better surgical performance,shorter surgical time,etc.while also improving intraoperative and postoperative safety and reducing patient stress.