经皮经肝胆囊穿刺引流术后择期行腹腔镜胆囊切除术治疗60岁以上急性重症胆囊炎患者的最佳时机探讨

赵红光; 刘凯; 刘亚辉

doi:10.3969/j.issn.1001-5256.2017.04.021

经皮经肝胆囊穿刺引流术后择期行腹腔镜胆囊切除术治疗60岁以上急性重症胆囊炎患者的最佳时机探讨

DOI: 10.3969/j.issn.1001-5256.2017.04.021

吉林大学第一医院肝胆胰外科

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中图分类号: R657.41
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出版历程
- 收稿日期: 2016-10-12
- 出版日期: 2017-04-20

The most appropriate timing for selective laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute severe cholecystitis aged above 60 years

Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University

摘要

摘要: 目的观察经皮经肝胆囊穿刺引流术（PTGD）后择期行腹腔镜胆囊切除术（LC）治疗老年急性重症胆囊炎的效果,探究择期手术的最佳时机。方法选取吉林大学第一医院肝胆胰外科2015年1月-2016年6月收治的行PTGD的60岁以上急性重症胆囊炎患者90例,根据择期LC时间将其分为3组:PTGD术后2个月内行LC（A组）、24个月行LC（B组）、4个月后行LC（C组）,每组30例,观察PTGD的治疗效果及择期LC效果。计量资料2组间比较采用t检验,多组间比较采用方差分析,进一步两两比较采用LSD-t检验。计数资料组间比较采用χ2检验。结果 90例患者均成功完成PTGD,腹痛缓解时间（2.52±0.76）h;术后2472 h内体温恢复正常,实验室指标（白细胞、中性粒细胞、ALT、AST、TBil）较术前均明显改善（t值分别为8.339、8.386、15.194、17.340、12.761,P值均<0.05）,无1例患者出现因穿刺所致的胆漏、胆道出血、气胸、结肠穿孔等并发症;无1例脱管再次行PTGD。3组患者的术前胆囊壁厚度、手术...
- 胆囊炎,急性 /
- 引流术 /
- 胆囊切除术,腹腔镜 /
- 老年人
Abstract: Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis, as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled, and according to the time of selective LC, they were divided into group A (with 2 months) , group B (2-4 months) , and group C (>4 months) , with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups, an analysis of variance was used for comparison between three groups, and LSD-t test was used for comparison between any two groups; the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD, and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery, and there were significant improvements in laboratory markers (white blood cell count, neutrophil count, and liver function) (all P<0.05) .No patient experienced complications such as bile leakage, hematobilia, pneumothorax, and colon perforation caused by puncture, and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F=8.029, P<0.001) , time of operation (F=24.674, P<0.001) , intraoperative blood loss (F=12.864, P<0.001) , length of hospital stay (F=22.844, P<0.001) , rate of conversion to laparotomy (χ2=12.345, P=0.002) , and incidence rate of complications (χ2=8.750, P=0.013) .Compared with group A, groups B and C had significantly lower gallbladder wall thickness before LC, intraoperative blood loss, length of hospital stay, rate of conversion to laparotomy, and incidence rate of complications (all P<0.05) , and group B had significantly lower time of operation, intraoperative blood loss, and length of hospital stay than group C (all P<0.05) .Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.
- cholecystitis, acute /
- drainage /
- cholecystectomy, laparoscopic /
- aged

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参考文献(27)

[1]XIA MF, ZHANG S, TIAN H, et al.Study of the effects of percutaneous transhepatic gallbladder drainage guided by B ultrasound in the treatment of elderly patients with critical calculus obstructive cholecystitis[J].China J Modern Med, 2014, 24 (21) :102-105. (in Chinese) 夏明峰, 张帅, 田虎, 等.B超引导下经皮肝胆囊穿刺治疗老年危重结石梗阻性胆囊炎[J].中国现代医学杂志, 2014, 24 (21) :102-105.

[2]HUA SY, XU RL, QI B, et al.Clinical value of percutaneous gallbladder catheterized drainage in the treatment of acute severe cholecystitis[J].J Southeast Univ:Med Sci Edit, 2014, 33 (4) :479-481. (in Chinese) 华双一, 徐仁良, 祁波, 等.经皮胆囊穿刺置管引流治疗高危急性胆囊炎[J].东南大学学报:医学版, 2014, 33 (4) :479-481.

[3]PEPINGCO L, ESLICK GD, COX MR.The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis[J].Med J Aust, 2012, 196 (8) :509-510.

[4]FEI HJ, SU ZJ, PAN QX, et al.Clinical effet of percutaneous transhepatic gallbladder drainage combined with selective laparoscopic cholecystectomy in treatment of acute severe cholecysitis:an analysis of 386 cases[J].J Hepatopancreatobiliary Surg, 2014, 26 (6) :486-488. (in Chinese) 费洪江, 苏子剑, 潘群雄, 等.经皮经肝胆囊穿刺引流术加择期腹腔镜胆囊切除术治疗急性重症胆囊炎386例分析[J].肝胆胰外科杂志, 2014, 26 (6) :486-488.

[5]ABI-HAIDAR Y, SANCHEZ V, WILLIAMS SA, et al.Revisiting percutaneous cholecystostomy for acute cholecystitis based on a10-year experience[J].Arch Surg, 2012, 147 (5) :416-422.

[6]JIANG B.The research of opportunity selection in acute calculous cholecystitis laparoscopic cholecystectomy[D].Dalian:Dalian Med Univ, 2014. (in Chinese) 江滨.急性结石性胆囊炎腹腔镜手术时机的选择[D].大连医科大学, 2014.

[7] Biliary Surgery Group, Surgery Branch of Chinese Medical Association.Diagnosis and treatment guidelines for acute biliary infection (2011 edition) [J].Chin J Dig Surg, 2011, 10 (1) :9-13. (in Chinese) 中华医学会外科学分会胆道外科学组.急性胆道系统感染的诊断和治疗指南 (2011版) [J].中华消化外科杂志, 2011, 10 (1) :9-13.

[8]YAMASHITA Y, TAKADA T, KAWARADA Y, et al.Surgical treatment of patients with acute cholecystitis:Tokyo guidelines[J].J Hepatobiliary Pancreat Surg, 2007, 14 (1) :91-97.

[9]XU D.Study on indications for extubation of percutaneous transhepatic gallbladder drainage[D].Shihezi:Shihezi Univ, 2014. (in Chinese) 徐东.经皮经肝胆囊穿刺引流术后拔管指征的探讨[D].石河子大学, 2014.

[10]JIANG JT, LI Q.Clinical effect of sequential percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in treatment of acute severe cholecystitis in elderly patients[J].Zhejiang Pract Med, 2015, 20 (3) :206-207. (in Chinese) 蒋建庭, 李巧.经皮经肝胆囊穿刺引流术序贯腹腔镜胆囊切除术治疗老年急性重症胆囊炎[J].浙江实用医学, 2015, 20 (3) :206-207.

[11]ZHANG JJ, LI HZ.Clinical analysis of Lidan Paishi Tang in expectant treatment of chronic cholecystitis[J].Chin J Exp Med Formul, 2016, 22 (7) :187-190. (in Chinese) 张洁靖, 李汉智.利胆排石汤保守治疗慢性胆囊炎的临床分析[J].中国实验方剂学杂志, 2016, 22 (7) :187-190.

[12]XIE MP, WANG J.Current research status of acute cholecystitis in elderly patients[J].Trauma Crit Med, 2016, 4 (1) :62-64. (in Chinese) 解民鹏, 王静.高龄患者急性胆囊炎研究现状[J].创伤与急危重病医学, 2016, 4 (1) :62-64.

[13]LENG K, LUO YQ, ZENG PF.Percutaneous transhepatic gallbladder catheterizing drainage guided by ultrasound for acute severe cholecystitis in the senile patients[J].China J Modern Med, 2014, 24 (24) :86-88. (in Chinese) 冷凯, 罗燕青, 曾鹏飞.老年急性胆囊炎经皮经肝胆囊穿刺引流术应用[J].中国现代医学杂志, 2014, 24 (24) :86-88.

[14]HUANG ZM, XU L, ZHOU D.Laparoscopic cholecystectomy for acute cholecystitis[J].Chin J Gen Surg, 2012, 21 (8) :1038-1040. (in Chinese) 黄志明, 徐亮, 周栋.腹腔镜胆囊切除术治疗急性胆囊炎[J].中国普通外科杂志, 2012, 21 (8) :1038-1040.

[15]WANG WH.Clinical efficacy of percutaneous transhepatic cholecystostomy combined with laparoscopic cholecystectomy for elderly patients with severe calculous cholecystitis[J].J Clin Hepatol, 2015, 31 (8) :1291-1294. (in Chinese) 王为华.经皮经肝胆囊穿刺造瘘术联合腹腔镜下胆囊切除术治疗60岁以上重症结石性胆囊炎患者的疗效观察[J].临床肝胆病杂志, 2015, 31 (8) :1291-1294.

[16]LIU C, ZHANG L.Clinical efficacy of transumbilical single-port laparoscopic cholecystectomy in treatment of acute cholecystitis[J].J Clin Hepatol, 2015, 31 (10) :1678-1681. (in Chinese) 刘超, 张磊.经脐单孔腹腔镜胆囊切除术治疗急性胆囊炎的效果评价[J].临床肝胆病杂志, 2015, 31 (10) :1678-1681.

[17]KOMATSU S, TSUKAMOTO T, IWASAKI T, et al.Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis[J].J Dig Dis, 2014, 15 (12) :669-675.

[18]CHOK KS, CHU FS, CHEUNG TT, et al.Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis[J].ANZ J Surg, 2010, 80 (4) :280-283.

[19]LIU H, FAN MM, CHANG YX, et al.Clincal analysis of cases converted to open surgery during laparoscopic cholecystectomy[J].Chin J Med Offic, 2016, 44 (8) :809-811. (in Chinese) 刘虎, 范明明, 常颜信, 等.腹腔镜胆囊切除术中转开腹临床分析[J].临床军医杂志, 2016, 44 (8) :809-811.

[20]CHEN MJ, ZHENG JB.Sequential laparoscopic cholecystectomy compared with simple laparoscopic cholecystectomy in treating eld-erly acute severe cholecystitis[J].Anhui Med J, 2013, 34 (6) :756-758.陈敏捷, 郑剑波.经皮经肝胆囊穿刺序贯腹腔镜胆囊切除治疗老年急性重症胆囊炎效果比较[J].安徽医学, 2013, 34 (6) :756-758.

[21]KWON YJ, AHN BK, PARK HK, et al.What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema?[J].Surg Endosc, 2013, 27 (10) :3776-3780.

[22]LO HC, WANG YC, SU LT, et al.Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation?A single institute experience of 74 cases[J].Surg Endosc, 2012, 26 (11) :3301-3306.

[23]YANG HQ, NIU JH, ZHANG SJ, et al.Laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with severe acute cholecystitis[J].J Abdominal Surg, 2012, 25 (2) :100-101. (in Chinese) 杨宏强, 牛建华, 张示杰, 等.高危急性胆囊炎经PTGD处理后再行腹腔镜胆囊切除术137例[J].腹部外科, 2012, 25 (2) :100-101.

[24]TAO P, WU XY, ZHANG L.Clinical effect of ultrasound-guided percutaneous transhepatic gallbladder drainage in treatment of acute cholecystitis in elderly patients[J].J Clin Hepatol, 2016, 32 (10) :1929-1931. (in Chinese) 陶平, 吴向阳, 张磊.超声引导经皮经肝胆囊穿刺引流术治疗老年急性胆囊炎的效果分析[J].临床肝胆病杂志, 2016, 32 (10) :1929-1931.

[25]JIANG HS, HUANG B, GAN WB.Percutaneous transhepatic gallbladder drainage combined with laparoscopiccholecystectomy in severe acute cho-lecystitis for the elderly patients[J].Sichuan Med, 2015, 36 (7) :999-1001. (in Chinese) 江华山, 黄斌, 甘文斌.经皮经肝胆囊穿刺引流后择期性腹腔镜胆囊切除治疗老年急性重症胆囊炎的临床观察[J].四川医学, 2015, 36 (7) :999-1001.

[26]QIU M.Timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis[D].Shihezi:Shihezi Univ, 2014. (in Chinese) 邱明.急性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择[D].石河子:石河子大学, 2014.

[27]JIANG QH, WANG AZ, CUI WH.The influence of operation effects of timing of the laparoscopic cholecystectomy after PTGD for acute cholecystitis[J].Modern Med J, 2015, 43 (7) :832-836. (in Chinese) 姜庆贺, 王爱芝, 崔文海.经肝胆囊穿刺置管引流术后不同手术时机对急性胆囊炎患者手术效果的影响[J].现代医学, 2015, 43 (7) :832-836.

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