目的: 探讨急性化脓性胆囊炎患者行经皮经肝胆囊穿刺引流（percutaneous transhepatic gallbladder drainage,PTGBD）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）序贯治疗的应用价值。方法: 收集2020年1月—2024年1月娄底市中心医院、中南大学湘雅医学院附属常德医院140例发病时间>72 h的急性化脓性胆囊炎患者为研究对象,根据接受的治疗方案不同分为研究组（序贯治疗组70例）和对照组（单纯LC组 70例）。比较两组患者术中、术后各项指标的变化情况和并发症发生率。结果: 研究组平均手术时间、术中出血量和术后总住院时间均少于对照组,术后首次排气时间,术后下床时间研究组均早于对照组。研究组患者术后感染指标白细胞计数、C-反应蛋白、白细胞介素-6水平均低于对照组。两组患者术后并发症发生情况：研究组肝功能不全3例,发热2例,对照组肝功能不全12例,术后胆瘘2例,出血1例,发热10例,中转开腹3例,胆道损伤2例（右后叶胆管损伤1例,肝总管损伤1例）,两组总体并发症发生率有统计学差异。结论: PTGBD联合LC序贯治疗在急性化脓性胆囊炎的患者中可减少并发症发生,缩短手术时间,减轻术后炎症反应,帮助患者术后快速康复。
Abstract
Objective To explore the application value of sequential treatment of percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) in patients with acute suppurative cholecystitis. Method 140 patients with acute suppurative cholecystitis who had onset time of more than 72 hours in Loudi Central Hospital and Changde Hospital affiliated to Xiangya Medical College of Central South University from January 2020 to January 2024 were collected as the research subjects. They were divided into the study group (70 cases in the sequential treatment group) and the control group (70 cases in the simple LC group) according to the different treatment plans received. The changes in various indicators and the incidence of complications during and after surgery were compared between the two groups. Results The average operation time, intraoperative blood loss, and total postoperative hospitalization time in the study group were all less than those in the control group. The first postoperative exhaust time and postoperative ambulation time in the study group were both earlier than those in the control group. The first laboratory scores of white blood cells, C-reactive protein, and serum IL-6 in the study group patients after surgery were statistically significant. The incidence of postoperative complications in the two groups of patients was as follows: 3 cases of hepatic insufficiency and 2 cases of fever in the study group, and 12 cases of hepatic insufficiency, 2 cases of postoperative biliary fistula, 1 case of bleeding, 10 cases of fever, 3 cases of conversion to open surgery, and 2 cases of biliary tract injury (1 case of right posterior lobe bile duct injury and 1 case of common hepatic duct injury) in the control group. There was a statistically significant difference in the overall incidence of complications. Conclusion PTGBD combined with LC sequential treatment can reduce the occurrence of complications, shorten the operation time, alleviate postoperative inflammatory reactions, and help patients recover quickly after surgery in patients with acute suppurative cholecystitis.
关键词
急性化脓性胆囊炎 /
胆囊穿刺 /
快速康复
Key words
acute suppurative cholecystitis /
gallbladder puncture /
rapid rehabilitation
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基金
娄底市科技局2024年临床医疗技术创新专项（202417）
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