摘要
目的为对急性胆囊炎患者经皮经肝胆囊穿刺置管引流术(PTGD)后一期腹腔镜胆囊切除术(LC)与二期LC治疗的效果进行比较,为临床治疗方式的选择提供参考。方法采用回顾性分析,收集我院2021年1月~2022年10月PTGD后行LC手术的92例急性胆囊炎患者资料,根据LC手术的时机分为PTGD后一期组(n=45,拔除引流管后72h内行LC手术,简称一期组)和PTCD后二期组(n=47,拔除引流管后2~4周行LC手术,简称二期组),比较两组手术相关指标、手术前后肝功能、血清炎性因子水平及并发症。结果两组术中出血量、术后肛门排气时间、胆囊壁厚度、LC手术难度评分、中转开腹数差异均无统计学意义(P>0.05)。二期组手术时间、术后住院时间长于一期组(P<0.05)。一期组LC后24hTBiL、AST、ALP、ALT、GCT水平均低于二期组(P<0.05)。LC后24h一期组hs-CRP、PCT、TNF-α、IL-6水平均低于二期组(P<0.05)。LC后24h两组IL-10水平差异无统计学意义(P>0.05)。一期组并发症发生率明显低于二期组(P<0.05)。结论仑PTCD后一期行LC可减轻炎性反应程度,有效保护肝功能,缩短患者手术和住院时间,降低术后并发症的发生率。
Objective To compare the therapeutic effects of primary laparoscopic cholecystectomy(LC)and secondary lapa-roscopic cholecystectomy(LC)afer percutaneous percutaneous cholecystectomy(PTGD)in patients with acute cholecystitis,and to provide reference for the selection of clinical treatment.Method Retrospective analysis was performed to collect the data of 92 pa-tients with acute cholecystitis who underwent LC surgery after PTCD in our hospital from January 2021 to October 2022.According to the timing of LC surgery,they were divided into the first-stage group after PTCD(n=45,LC surgery within 72 h after drainage tube removal,referred to as the first-stage group)and the second-stage group after PTGD(n=47),Two to four weeks after the drainage tube was removed,LC was performed(Phase Ⅱ group),and the relevant indicators of surgery,liver function before and after surgery,serum inflammatory factor levels and complications were compared between the two groups.Results There were no significant differences in intraoperative blood loss,postoperative anal exhaust time,gallbladder wall thickness,LC operation difficulty score and number of conversion to laparotomy between the two groups(P>0.05).The operation time and postoperative hospital stay of the phase Ⅱ group were longer than those of the phase Ⅰ group(P<0.05).The levels of 24 hTBiL,AST,ALP,ALT and GCT in phase Ⅰ group after LC were lower than those in phase Ⅱ group(P<0.05).The levels of hs-CRP,PCT,TNF-αand IL-6 in phase Ⅰ group were lower than those in phase Ⅱ group 24 h after LC(P<0.05).There was no significant dfference in IL-10 level between the two groups at 24 h after LC(P>0.05).The complication rate of phase Ⅰ group was significantly lower than that of phase Ⅱ group(P<0.05).Conclusion One-stage LC after PTGD can reduce inflammatory response,effectively protect liver function,shorten the length of operation and hospital stay,and reduce the incidence of postoperative complications.
作者
许春生
孙光明
XU Chun sheng;SUN Guang-ming(The Dongda Hospital of Shanxian,Heze 274300,China)
出处
《肝胆外科杂志》
2024年第1期48-52,共5页
Journal of Hepatobiliary Surgery
关键词
急性胆囊炎
经皮经肝胆囊穿刺置管引流术
一期腹腔镜手术
二期腹腔镜手术
效果
acute cholecystitis
percutaneous transhepatogallbladder puncture catheter drainage
primary laparoscopic surgery
secondary laparoscopic surgery
effect
