王艺桦1,,
范罡贤2,
匡立润1,
谢锋3,
韩红民1,
刘峥嵘1,,
1. 中国医科大学辽宁省人民医院 普外科, 辽宁 沈阳 110001
2. 滨州医学院附属医院 外科, 山东 滨州 256603
3. 中国医科大学辽宁省人民医院 核医学科, 辽宁 沈阳 110001
详细信息 作者简介: 王艺桦(1993-), 女, 硕士研究生。E-mail: 592654115@qq.com
通讯作者: 刘峥嵘, 教授。E-mail: lzr175@sina.com 中图分类号: R657.4+1
摘要:目的探讨发病时间>72 h的GRADE Ⅱ急性胆囊炎患者,一期腹腔镜胆囊切除术(LC)与经皮经肝胆囊穿刺引流术(PTGD)后LC的疗效对比,及行LC的最佳时机。方法回顾性分析2016年10月至2019年8月辽宁省人民医院收治的123例急性胆囊炎患者的临床资料,根据LC前是否行PTGD治疗分为PTGD组(n=36)和非PTGD组(n=87);根据发病距离手术的时间将非PTGD组再分为3组: A组(n=41)发病距手术时间>72 h,≤1周;B组(n=29)发病距手术时间>1周,≤2周;C组(n=17)发病距手术时间>2周。比较行LC术后实验室指标恢复正常时间、临床症状缓解时间、手术及住院情况、术中及术后并发症发生率等。结果PTGD组与非PTGD组在腹痛消失时间、经口进食时间、手术时长、出血量、带管时长、术中及术后并发症发生率等方面差异无统计学意义(P>0.05);但胆囊壁厚度、住院时长、住院费用差异有统计学意义(P < 0.05);PTGD组与非PTGD组在总体疗效方面没有明显差异。C组与A、B两组实验室指标WBC、ALT、ALP恢复正常的时间,腹痛消失时间差异有统计学意义(P < 0.05);A、B、C3组在CRP及TBIL恢复正常的时间,体温恢复时间,经口进食时间,胆囊壁厚度,手术时长,出血量,带管时间,住院时间,住院费用等方面差异有统计学意义(P < 0.05);非PTGD组平均治疗效果A组优于B组优于C组。结论PTGD组与非PTGD组在单纯行LC的疗效上无明显差异。对于发病时间>72 h的GRADE Ⅱ急性胆囊炎患者,若能耐受手术,推荐尽早行一期LC治疗。
关键词: GRADE Ⅱ急性胆囊炎/
腹腔镜胆囊切除/
经皮经肝胆囊穿刺引流术/
东京指南
Abstract:ObjectiveTo compare the efficacy of one-stage laparoscopic cholecystectomy (LC) and LC after percutaneous transhepatic gallbladder drainage (PTGD) in patients with GRADE Ⅱ acute cholecystitis whose onset time was longer than 72 hours.MethodsThe clinical data of 123 patients with acute cholecystitis admitted to Liaoning Provincial People's Hospital from October 2016 to August 2019 was retrospectively analyzed. According to PTGD treatment was performed before LC or not, they were divided into PTGD group(n=36) and non-PTGD group (n=87). According to the time from onset to operation, the non-PTGD group patients were divided into group A (n=41), B (n=29) and C (n=17). The time for the laboratory indicators to return to normal after LC operation, the time of clinical symptoms relief, the operation and hospitalization, and the incidence of intraoperative and postoperative complication were analyzed.ResultsThere was no significant difference in the time of disappearance of abdominal pain, oral feeding, the length of operation, the amount of bleeding, length with tube and the incidence of intraoperative and postoperative complication between the PTGD and the non-PTGD group (P>0.05). Although thickness of gallbladder wall, length of hospitalization and the cost of hospitalization were different between them (P < 0.05), the overall efficacy was similar. In the non-PTGD group, patients in group C needed a longer time of WBC, ALT, ALP returning to normal and disappearance of abdominal pain than group A and group B (P < 0.05). The three groups A, B and C showed statistically significant differences in the recovery time of CRP and TBIL, the recovery time of body temperature and oral feeding, the thickness of gallbladder wall, the length of operation, the amount of bleeding, length of time with tube, length and cost of hospitalization, etc. On average, the group A showed the best efficacy, whereas the group C the worst (P < 0.05).ConclusionPTGD before LC would not increase the efficacy. Immediate surgical treatment would be better for patients whose onset time of the GRADE Ⅱ acute cholecystitis is more than 72 hours.
Keywords:GRADE Ⅱ acute cholecystitis/
laparoscopic cholecystectomy/
percutaneous transhepatic gallbladder drainage/
Tokyo Guidelines
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