摘要
目的：探讨经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage,PTGD）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗急性结石性胆囊炎的时机。方法：选取2010年2月至2015年2月98例急性结石性胆囊炎患者,根据PTGD与LC的时间间隔分为早期组（2个月）、中期组（2-4个月）及晚期组（4-6个月）。术前行B超检查测定胆囊壁厚度,检测白细胞计数,对比中转例数、术中出血量、手术时间及术后恢复时间等指标。结果：早期组患者术前胆囊壁厚度、白细胞计数、中转率高于中、晚期组,晚期组中转率、白细胞计数明显高于中期组;早期组手术时间、术中出血量及住院时间均高于中、晚期组,差异有统计学意义（P〈0.05）。晚期组手术时间、术中出血量及住院时间明显高于中期组（q=4.563、9.345、6.334;P=0.004、0.000、0.001）;成功行LC的患者胆囊壁厚度小于中转开腹的患者（t=7.777,P=0.000）,且手术时间、术中出血量、住院时间均低于中转开腹患者（P〈0.05）。结论：急性结石性胆囊炎患者于PTGD治疗后2-4个月行LC可减少术中出血量、缩短手术时间与术后住院时间,利于患者的恢复。
Objective： To explore the timing of the laparoscopic cholecystectomy （LC） after percutaneous transhepatic gallblad- der drainage （PTGD） for acute calculous cholecystitis. Methods：A total of 98 patients diagnosed with acute calculous cholecystitis in general surgery of baoji Chinese medicine hospital were selected between Feb. 2010 and Feb. 2015. All patients were divided into the early group （2 months） ,the medium group （2-4 months） and the late group （4-6 months） according to the time interval of PTGD and LC. The gallbladder wall thickness, while blood cell count, the patients converted from laparoscopy to laparotomy, intraoperative blood loss, operative time and postoperative recovery were recorded to evaluate the effect. Results： The gallbladder wall thickness, while blood cell count and conversion rate of the early group were higher than the other groups, while blood cell count and conversion rate of late group were higher than the medium group. The operation time, intraoperative blood loss and length of hospital stay of the early group were higher than the medium and late groups with significant difference （P 〈 0.05）. The operation time, intraoperative blood loss and length of hospital stay of the late group were significantly higher than those of the medium group （ q = 4.563,9. 345,6. 334 ; P = 0.004, 0. 000,0.001 ）. The gallbladder wall thickness Of successful LC patients was less than that of laparotomy patients （ t = 7. 777, P = 0.000） as well as the operation time, intraoperative blood loss, and hospital stay （P 〈 0.05 ）. Conclusions：The LC that is operated in 2-4 months after PTGD for patients with acute calculous cholecystitis can reduce intraoperative blood loss, shorten the operation time and postoperative hospital stay,which is beneficial to the recovery of patients.
出处
《腹腔镜外科杂志》
2016年第7期550-553,共4页
Journal of Laparoscopic Surgery
关键词
急性结石性胆囊炎
经皮经肝胆囊穿刺引流术
胆囊切除术
腹腔镜
时机
Acute calculous cholecystitis
Percutaneous transhepatic gallbladder drainage
Cholecystectomy, laparoscopic
Opportunity
