摘要
目的 评价高危Ⅱ级急性胆囊炎患者紧急腹腔镜胆囊切除术(Lap-C)与经皮肝穿刺胆囊引流术(PTGBD)后选择性Lap-C的疗效和安全性。方法 选取2021年1月至2023年1月的高危Ⅱ级急性胆囊炎患者105例,发病后进行紧急Lap-C手术为紧急组66例,行PTGBD治疗后选择性Lap-C手术为延期组39例。比较两组临床资料和手术结果,分析围手术期主要并发症的影响因素。结果 紧急组男性比率、血肌酐和降钙素原水平均低于延期组,身体质量指数、血小板水平、呕吐和Murphy征阳性比率、超声下胆囊粘连和胆囊壁厚度增加表现均高于延期组。两组手术时间、术中出血量、中转开腹、并发症发生率、术后拔管时间、镇痛剂需求和术后住院时间无明显差异。高龄和较多的术中出血量是患者围手术期主要并发症的独立危险因素,而单独的CCI≥6或ASA-PS≥3以及紧急胆囊切除术不是危险因素。结论 高危Ⅱ级急性胆囊炎患者紧急Lap-C不会增加患者并发症及住院时间,可能比PTGBD后选择性Lap-C更为有利。
Objective To evaluate the efficacy and safety of elective Lap-C after percutaneous transhepatic gallbladder drainage(PTGBD) and emergency laparoscopic cholecystectomy(Lap-C) for grade Ⅱ acute cholecystitis.Methods Totally 105 patients with high-risk grade Ⅱ acute cholecystitis were selected from January 2021 to January 2023. 66 patients underwent emergency Lap-C surgery after onset, and 39 patients underwent elective Lap-C surgery after PTGBD treatment. The clinical data and surgical results of the two groups were compared, and the influencing factors of perioperative complications were analyzed.Results Totally the male ratio, SCr and PCT levels in the emergency group were lower than those in the delay group. BMI, platelet levels, positive rates of vomiting and Murphy sign, ultrasound gallbladder adhesion and increased gallbladder wall thickness were higher than those of the delay group. There were no significant differences in operation time, intraoperative blood loss, conversion to laparotomy, incidence of complications, postoperative extubation time, analgesic need and postoperative hospital stay between the two groups. Advanced age and more intraoperative blood loss were independent risk factors for major perioperative complications, while CCI≥6 or ASA-PS≥3 alone and emergency cholecystectomy were not risk factors.Conclusion Emergency Lap-C in high-risk patients with grade Ⅱ acute cholecystitis does not increase complications and length of hospital stay, and may be more beneficial than selective LC after PTGBD.
作者
王培民
王莹
牛玉玉
WANG Pei-min;WANG Ying;NIU Yu-yu(Department of General Surgery,Xinxiang the First Peoples Hospital,Xinxiang,Henan 453000,China;Department of Cardiovascular,Xinxiang the First Peoples Hospital,Xinxiang,Henan 453000,China)
出处
《医药论坛杂志》
2024年第3期256-260,共5页
Journal of Medical Forum
关键词
经皮肝穿刺胆囊引流
胆囊结石
急性胆囊炎
腹腔镜胆囊切除术
Percutaneous transhepatic gallbladder drainage
Gallstones
Acute cholecystitis
Laparoscopic cholecystectomy
