经皮肝胆囊穿刺引流术联合腹腔镜胆囊切除手术治疗急性重症胆囊炎的临床疗效分析

发布时间：2018-03-13 08:37

本文选题：经皮肝胆囊穿刺引流术　切入点：腹腔镜胆囊切除手术　出处：《中华医院感染学杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的探讨经皮肝胆囊穿刺引流术(PTGBD)联合腹腔镜胆囊切除手术(LC)治疗高危急性胆囊炎患者的临床效果。方法选取2013年1月-2016年4月在解放军总医院肝胆外科手术治疗147例急性危重胆囊炎患者进行回顾性分析,根据患者LC术前是否接受PTGBD治疗分为联合组71例、LC组76例,对比两组患者的围手术期指标、术后实验室指标的差异。结果联合组术中失血(80.3±18.2)ml、腹腔引流时间(3.5±1.2)d、进食时间(3.0±1.1)d均显著的低于LC组(116.4±24.6)ml、(4.3±1.5)d、(4.2±1.5)d,差异均有统计学意义(P0.05);两组患者手术时间、术后住院时间比较差异无统计学意义;联合组和LC组患者治疗前的体温、WBC计数、血清碱性磷酸酶(ALP)、总胆红素(TBIL)、视觉模拟疼痛评分(VAS)差异均无统计学意义;术后72h,联合组白细胞计数(6.4±1.7)109/L、血清ALP(98.3±11.2)U/L、TBIL(22.7±7.1)μmol/L、VAS评分(1.6±0.8)分均显著低于LC组患者(8.9±2.5)109/L、(113.8±15.0)U/L、(27.0±8.3)μmol/L、(2.3±1.0)分,差异均有统计学意义(P0.05);联合组和LC组患者肺部感染率、切口感染率、中转开腹率比较差异无统计学意义。结论 PTGBD联合LC治疗高危急性胆囊炎患者较单纯的LC手术更有利于患者术后恢复。
[Abstract]:Objective to investigate the clinical effect of percutaneous transhepatic cholecystectomy (PTGBD) combined with laparoscopic cholecystectomy (LC) in the treatment of high risk acute cholecystitis. A retrospective analysis of 147 patients with acute severe cholecystitis was made. According to whether or not the patients received PTGBD before LC, they were divided into two groups: the combined group (71 cases) and the LC group (76 cases). The perioperative indexes of the two groups were compared. Results the blood loss, abdominal drainage time and feeding time in the combined group were significantly lower than those in the LC group (116.4 卤24.6ml, 4.3 卤1.5d, 4.2 卤1.5g / d, P < 0.05), and the time of abdominal drainage was 3.5 卤1.2g / d, and the feeding time was 3.0 卤1.1g / d, respectively, which was significantly lower than that in the LC group (4.2 卤1.5g / d), and the operative time of the two groups was significantly lower than that of the LC group (P < 0.05). There was no significant difference in postoperative hospitalization time, WBC count, serum alkaline phosphatase, total bilirubin TBILN and visual analogue pain score (VASs) in patients with combined group and LC group before treatment. At 72 hours after operation, the white blood cell count of the combined group was significantly lower than that in the LC group (6.4 卤1.7 卤1.7 卤109 / L, ALP(98.3 卤11.2U / L / L = 22.7 卤7.1) 渭 mol / L / L and 1.6 卤0.8), respectively, which was significantly lower than that in the LC group (113.8 卤2.5109L / L + 15.0U / L = 27.0 卤8.3u mol / L = 2.3 卤1.0), and the lung infection rate, incision infection rate, incision infection rate in the combined group and LC group were significantly lower than those in the LC group (27.0 卤8.3 渭 mol / L = 2.3 卤1.0), and the lung infection rate, incision infection rate, incision infection rate in the combined group and LC group were significantly lower than those in the LC group. Conclusion PTGBD combined with LC is more beneficial to postoperative recovery in patients with high risk acute cholecystitis than LC alone.
【作者单位】：解放军总医院急诊科;胜利油田中心医院急诊科;麻城市人民医院肝胆外科;
【分类号】：R657.4

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