Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage

BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.

Evaluation of the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis

Objective: To study the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis. Methods: A total of 86 patients with severe acute cholecystitis who received surgical treatment in Yulin Second Hospital between April 2013 and April 2017 were selected as the research subjects and randomly divided into two groups, observation group of patients received percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery, control group of patients received emergency laparoscopic surgery, and serum was collected the same day and 3 d after operation to determine the inflammation indexes, stress response indexes and immune response indexes. Results: The same day after operation and 3 d after operation, serum HMGB-1, IL-2, IL-6, hs-CRP, ET-1, ACTH, Cor and MDA levels as well as peripheral blood CD8+ levels of observation group were significantly lower than those of control group while serum SOD, IgG, IgM and IgA levels as well as peripheral blood CD3+ and CD4+ levels were significantly higher than those of control group. Conclusion: Percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis can improve the postoperative inflammatory response, stress response and immune response.

Peritoneal bleeding due to percutaneous transhepatic gallbladder drainage:An autopsy report

A 77-year-old man underwent percutaneous transhepatic gallbladder drainage(PTGBD) for acute cholecystitis as a preoperative procedure;however,he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died.There were three centesis scars for the PTGBD,and only one pathway from the most dorsal centesis scar reached the gallbladder.Microscopically,the PTGBD pathway crossed and injured the intrahepatic arterial wall,and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver.Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder.Consequently,the PTGBD caused lethal bleeding.When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface,it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.

Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage

A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.

Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma

AIM： To estimate the incidence of catheter tract implantation metastasis among patients undergoing percutaneous transhepatic biliary drainage （PTBD） for extrahepatic cholangiocarcinoma, and to provide data regarding the management of this unusual complication of PTBD by reviewing cases reported in the literature. METHODS： A retrospective analysis of 67 consecutive patients who underwent PTBD before the resection of extrahepatic cholangiocarcinoma was conducted. The median follow-up period after PTBD was 106 too. The English language literature （PubMed, National Library of Medicine, Bethesda, MD, USA）, from .lanuary 1966 through December 2004, was reviewed. RESULTS： Catheter tract implantation metastasis developed in three patients. The cumulative incidence of implantation metastasis reached a plateau （6%） at 20 mo after PTBD. All of the three patients with implantation metastasis died of tumor progression at 3, 9, and 20 mo after the detection of this complication. Among the 10 reported patients with catheter tract implantation metastasis from extrahepatic cholangiocarcinoma （including our three patients）, two survived for more than 5 years after the excision of isolated catheter tract metastases. CONCLUSION： Catheter tract implantation metastasis is not a rare complication following PTBD for extrahepatic cholangiocarcinoma. Although the prognosis for patients with this complication is generally poor, the excision of the catheter tract may enable survival in selected patients with isolated metastases along the catheter tract.

超声引导下一步法行经皮经肝胆囊穿刺引流术在急性重症胆囊炎治疗中的应用

目的探讨超声引导下采用一步法行经皮经肝胆囊穿刺引流术(PTGD)在急性重症胆囊炎(ASC)治疗中临床效果。方法选择2020年1月至2023年5月在安徽医科大学第二附属医院接受PTGD治疗的ASC患者30例,其中男性19例,女性11例;年龄55~78岁,平均年龄67岁;病程42~64 h,平均病程55.77 h。行PTGD,统计视觉模拟量表(VAS)评分;对临床症状缓解患者行腹腔镜下胆囊切除术(LC)。比较其术前、术后第1天胆囊长径、胆囊宽径及术前、术后第1天、术后第3天感染指标变化;分析患者术后第1天、第2天、第3天腹痛缓解率;分析患者术后并发症发生情况。结果30例患者均一次性穿刺置管成功。术后第1天、第2天、第3天患者腹痛症状缓解率分为86.7%(26/30)、96.7%(29/30)和100.0%(30/30)。其中26例患者于术后5~6周后行LC。患者术后第1天胆囊长径、胆囊宽径均较术前减小[(76.58±8.62)mm vs(105.35±14.84)mm、(28.71±5.29)mm vs(41.25±3.41)mm。P<0.05]。患者最高体温、白细胞计数(WBC)、中性粒细胞比例(NEU%)、C反应蛋白(CRP)水平及VAS评分在术后第1天、术后第3天均较术前下降,且术后第3天低于术后第1天(P<0.05)。术后出现1例发生引流管脱管,1例胆汁引流不畅,但均未出现出血、胆汁漏、血气胸等严重并发症。结论在ASC的治疗中,采用超声引导下一步法行PTGD治疗可以减轻患者疼痛,改善炎症指标,降低术后并发症的发生。

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

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。

经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术序贯治疗急性胆囊炎最佳手术时机的临床研究

目的探讨经皮经肝胆囊穿刺引流(PTGBD)联合腹腔镜胆囊切除术(LC)序贯治疗急性胆囊炎的最佳手术时机。方法选取2021年6月至2022年6月于九江市第一人民医院接受PTGBD联合LC序贯治疗的66例急性胆囊炎患者作为研究对象,根据手术时间不同分为对照组与观察组,每组33例。对照组于发病后1周内行PTGBD,观察组于发病1周后行PTGBD,两组均择期行LC序贯治疗。比较两组围手术期指标、治疗前后肝功能指标、炎症因子指标及术后并发症和中转开腹发生率。结果两组住院费用比较差异无统计学意义;观察组术中出血量少于对照组,手术时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗后,观察组冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT、)、γ-谷氨酰基转移酶(γ-GT)水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症及中转开腹发生率均低于对照组,差异有统计学意义(P<0.05)。结论发病1周后行PTGBD联合LC序贯治疗急性胆囊炎,可有效改善患者肝功能,快速降低机体炎症因子水平,且可减少中转开腹及术后并发症的发生,手术风险更低,有助于促进患者术后尽快恢复,值得临床应用推广。

PTGBD治疗TG18中重度急性胆囊炎123例临床疗效分析

目的探讨经皮经肝胆囊穿刺置管外引流术(PTCBD)治疗东京指南2018(TC18)中重度急性胆囊炎临床疗效分析。方法回顾性分析我院2021年6月至2023年5月我科诊治的123例TG18中重度急性胆囊炎行PTCBD治疗患者的资料,分析其安全性、有效性,择期手术的中转开腹率。结果123例患者均一次性行PTCBD治疗成功,住院期间无PTGBD相关的并发症或死亡,术后24小时内症状基本缓解,123例患者中有99例择期行手术治疗,中转开腹2例,中转开腹率2.02%。结论对于中重度急性胆囊炎患者行PTCBD治疗安全有效,提高手术的安全性及微创率。

术前不同减黄策略对胰腺癌手术疗效及预后的影响研究

目的 观察术前不同减黄策略对胰腺癌患者手术疗效及预后的影响。方法 本研究为前瞻性研究,以郑州大学第一附属医院2021年1月至2022年12月收治的119例胰腺癌患者为研究对象,基于随机、对照原则,采用电脑分组法将入组患者分为A组(60例)、B组(59例),A组术前采用内镜下逆行胆管引流术(ERBD)治疗,B组术前采用经皮肝胆管穿刺引流术(PTBD)治疗,所有患者术后开展为期1年随访,比较2组患者的肝功能、凝血功能、营养状态、并发症发生、治疗及远期生存情况。结果 在不同术前减黄策略下,A组患者的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)分别为(35±5)U/L、(35±5)U/L、(15±3)μmol/L,均低于B组[(39±5)U/L、(38±5)U/L、(18±3)μmol/L];A组患者的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血时间(TT)分别为(28±5)s、(11±3)s、(17±3)s,均低于B组[(32±5)s、(13±3)s、(19±3)s];A组患者的血红蛋白(Hb)、总蛋白(TA)、白蛋白(ALB)分别为(118±20)g/L、(66±10)g/L、(45±10)g/L,均高于B组[(104±20)g/L、(60±10)g/L、(40±10)g/L];A组患者的并发症发生率6.7%(4/60)低于B组20.3%(12/59);A组患者的减黄时间、住院时间、30 d内死亡率分别为(14±3)d、(35±5)d、1.7%(1/60),均低于B组[(17±3)d、(39±5)d、15.2%(9/59)];中位无进展生存期(PFS)、中位总生存期(OS)分别为(10.2±2.2)月、(11.5±3.2)月,均高于B组[(8.3±1.3)月、(9.4±2.2)月](P<0.05)。结论 术前实施ERBD能有效改善胰腺癌患者的肝功能、凝血功能及营养状态,对加快患者康复进程、降低并发症发生风险并延长生存周期均有积极意义。

纳米消融术辅助PTCD治疗晚期胆囊癌的效果分析

目的分析纳米消融术辅助经皮肝穿刺胆道引流术(PTCD)治疗晚期胆囊癌的效果。方法选取106例晚期胆囊癌患者,按照随机数字表法分为手术组和联合组,每组53例。手术组采用PTCD治疗,联合组采用纳米消融术辅助PTCD治疗,比较两组的近期疗效及短期预后情况。结果术后1周、4周,联合组的血清总胆红素(TBIL)水平、糖类抗原199(CA199)、谷丙转氨酶(ALT)、谷草转氨酶(AST)均低于手术组,差异有统计学意义(P<0.05);联合组T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于手术组(P<0.05);联合组1年内生存率、中位无进展生存期(PFS)、中位总生存期(OS)均高于手术组(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论纳米消融术辅助PTCD治疗,能增强晚期胆囊癌患者近期疗效,减轻肝损伤,增强免疫功能,对改善患者短期预后有积极意义。

超声引导下PTGD联合聚桂醇硬化治疗单纯性肝囊肿患者疗效研究

目的探讨在超声引导下经皮经肝胆囊穿刺引流术(PTGD)联合聚桂醇硬化治疗单纯性肝囊肿(SHC)患者的疗效。方法2021年6~2022年8月我院收治的SHC患者67例,采用随机数字表法将其分为观察组34例和对照组33例,两组均行超声引导下PTGD术治疗,只是在对照组给予无水乙醇硬化治疗,在观察组给予聚桂醇硬化治疗。治疗后随访6个月。采用ELISA法检测血清皮质醇(Cor)水平,采用化学发光法检测血清淀粉样蛋白A(SAA)和C反应蛋白(CRP)水平。结果在治疗6个月末,观察组总有效率为97.1%,与对照组的93.9%比,无统计学差异(P>0.05);在治疗后1个月、3个月和6个月末,观察组囊肿体积缩小率分别为(69.1±7.3)%、(84.6±6.9)%和(92.8±3.2)%,显著大于对照组【分别为(56.8±6.4)%、(75.3±5.7)%和(86.3±4.9)%,P<0.05】;治疗前和治疗后1周,两组血清TBIL、AST、ALT和ALP水平比较,无显著性差异(P>0.05);在治疗1周末,观察组血清Cor和SAA水平分别为(260.4±15.6)nmol/L和(13.9±2.1)mg/L,均显著低于对照组【分别为(305.8±18.9)nmol/L和(18.6±2.7)mg/L,P<0.05】;观察组不良反应发生率为5.8%,显著低于对照组的24.2%(P<0.05)。结论采用超声引导下PTGD联合聚桂醇硬化治疗SHC患者疗效确切,能有效缩小囊肿体积,缓解应激反应,降低不良反应发生率。

急性重症胆囊炎急诊手术与胆囊穿刺术后择期手术疗效比较的Meta分析

目的:通过Meta分析比较急性重症胆囊炎急诊行腹腔镜胆囊切除术(LC)与超声引导下经皮经肝胆囊穿刺引流术(PTGBD)后择期行LC的临床疗效。方法:检索国内外多个数据库中关于急性重症胆囊炎急诊LC与PTGBD后择期行LC疗效比较的文献。检索时间为2015年1月1日至2023年8月31日。观察指标包括手术时间、术中出血量、术后住院时间、中转开腹率、术后腹腔引流时间、胃肠功能恢复时间、切口感染率、胆漏发生率、胆管损伤发生率及总并发症发生率,提取相关数据后应用RevMan 5.4软件进行Meta分析。结果:共纳入23项研究,累计样本量2097例,急诊LC组1008例、PTGBD联合LC组1089例。Meta分析结果显示,急诊LC组手术时间(WMD=-24.39,95%CI=-32.35~-16.44,P<0.00001)、术后腹腔引流时间(WMD=-1.96,95%CI=-2.56~-1.36,P<0.00001)、胃肠功能恢复时间(WMD=-1.03,95%CI=-1.37~-0.69,P<0.00001)、术后住院时间(WMD=-1.77,95%CI=-2.61~-0.93,P<0.0001)更长;术中出血量(WMD=-44.75,95%CI=-54.33~-35.17,P<0.00001)更多,中转开腹率(OR=0.38,95%CI=0.24~0.61,P<0.0001)、切口感染率(OR=0.37,95%CI=0.18~0.75,P=0.006)、胆漏发生率(OR=0.24,95%CI=0.13~0.44,P<0.00001)、胆管损伤发生率(OR=0.30,95%CI=0.10~0.90,P=0.03)、总并发症发生率(OR=0.26,95%CI=0.19~0.35,P<0.00001)高于PTGBD联合LC组。结论:急性重症胆囊炎经PTGBD后择期行LC的临床疗效优于急诊LC,是安全、可行的。

内镜鼻胆囊引流治疗胆总管结石合并急性化脓性胆囊炎

目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。

急性胆囊炎患者经皮经肝穿刺胆囊引流术后序贯腹腔镜胆囊切除术的最佳手术时机

目的探讨急性胆囊炎患者行经皮经肝穿刺胆囊引流术(PTGBD)术后序贯行腹腔镜胆囊切除术(LC)的最佳手术时机。方法回顾性分析2019年10月至2022年10月在郑州大学第一附属医院先行PTGBD手术后行序贯LC手术的100例急性胆囊炎患者的临床资料。依据患者行PTGBD手术后序贯LC手术的间隔时间分为A组47例(PTGBD后5~8周行LC术)与B组53例(PTGBD后3~4周行LC术)。比较两组一般资料、围手术期指标、炎症因子及并发症发生率。结果两组OTGBD术后序贯LC术前年龄、白细胞计数、γ-谷氨酰转肽酶、美国麻醉医师协会分级、察尔森合并症指数评分及性别差异无统计学意义(P>0.05)。A组术中出血量少于对照组,手术时间、排气时间及住院时间均短于B组,差异有统计学意义(P<0.05),但两组胆囊壁厚度差异无统计学意义(P>0.05)。A组肿瘤坏死因子、白细胞介素-2及C反应蛋白水平均低于B组,差异有统计学意义(P<0.05)。A组并发症发生率(4.26%)低于B组(18.87%),差异有统计学意义(P<0.05)。两组中转开腹例数差异无统计学意义(P>0.05)。结论急性胆囊炎患者PTGBD术后序贯LC术的最佳手术时机为PTGBD术后5~8周。

清肝利胆法配合胆囊穿刺引流治疗高龄重症急性胆囊炎临床研究

目的:探讨给予高龄重症急性胆囊炎患者胆囊穿刺引流+清肝利胆法治疗的效果。方法:选取医院收治的60例高龄重症急性胆囊炎患者,经随机数表法分为两组。对照组(30例)患者进行超声引导下经皮肝胆囊穿刺置管引流术(PTGBD)治疗,治疗组(30例)患者进行PTGBD+清肝利胆法治疗。观察患者相关血清指标、炎性因子水平变化情况及临床症状体征改善、总疗效。结果:两组经过治疗后,治疗组患者WBC、ALT及GGT水平相比治疗前、对照组均明显更低,差异有统计学意义(P<0.05);治疗组患者CRP、IL-6及TNF-α水平均低于治疗前,同时低于对照组,差异有统计学意义(P<0.05);治疗后,治疗组患者各项中医症候评分相比对照组均更低,差异有统计学意义(P<0.05);两组患者临床治疗总有效率分别为73.33%、90.00%,治疗组总有效率明显更高,差异有统计学意义(P<0.05)。结论:选用PTGBD+清肝利胆法的中西医结合方案,给予高龄重症急性胆囊炎患者治疗,能够更好地改善患者相关血清指标、炎性因子水平,减少患者不适情况,提高患者临床症状和体征的改善效果,获得更理想总体疗效。

超声引导下经皮经肝胆囊穿刺引流术治疗急性胆囊炎的临床效果

目的 探讨超声引导下经皮经肝胆囊穿刺引流术(PTGBD)治疗急性胆囊炎(AC)患者的临床效果。方法 选取2021年9月至2023年10月在新乡市第一人民医院接受治疗的AC患者共计100例,以随机数字表法分为研究组(n=50)与对照组(n=50),对照组采用腹腔镜胆囊切除术(LC)治疗,研究组采用超声引导下PTGBD治疗,对两组围手术期指标、疼痛程度[视觉模拟评分法(VAS)]、肝功能指标[血清碱性磷酸酶(ALP)、间接胆红素(IBIL)、总胆红素(TBIL)]、炎性应激指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、白细胞计数(WBC)]、术后并发症进行比较。结果 研究组手术时间、肛门首次排气时间、住院时间较对照组短,术中出血量较对照组少,差异具有统计学意义(P <0.05);两组术后VAS评分较术前下降,且研究组术后VAS评分低于对照组,差异有统计学意义(P <0.05);两组术后ALP、IBIL、TBIL水平较术前下降,且研究组术后上述指标水平均低于对照组,差异具有统计学意义(P <0.05);两组术后TNF-α、IL-6、CRP、WBC水平较术前下降,且研究组术后上述指标均低于对照组,差异具有统计学意义(P <0.05);研究组术后并发症发生率(4.00%)低于对照组(18.00%),差异具有统计学意义(P <0.05)。结论 超声引导下PTGBD应用于AC患者治疗中,能够改善围手术期指标,降低疼痛程度,改善肝功能指标及炎性应激指标,减少术后并发症发生。

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

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。