经皮经肝胆囊穿刺置管引流术后胆囊不同切除时机对急性胆囊炎患者手术效果的影响
|
摘要
目的探讨经皮经肝胆囊穿刺置管引流术(PTGD)术后胆囊不同切除时机对急性胆囊炎患者手术效果的影响。方法回顾性分析2015年6月至2017年12月于我院治疗的147例急性胆囊炎患者的临床资料,根据不同腹腔镜胆囊切除手术(LC)时机分为A组25例、B组79例、C组43例,A组PTGD术后2个月内行LC术,B组PTGD术后2～4个月内行LC术,C组PTGD术后4个月行LC术,比较3组疗效。结果 B组、C组患者术前胆囊壁厚度显著小于A组,B组患者手术时间、术后排气时间、排便时间、住院时间显著短于A组、C组,术中出血量、中转开腹率、并发症率显著少于A组、C组(P<0.05)。B组LC术前白细胞介素(IL)-2、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)水平显著低于A组、C组,IL-4水平显著高于A组、C组(P<0.05)。3组LC术前免疫功能指标比较差异无统计学意义(P>0.05)。结论 PTGD术后2～4个月内行LC术治疗急性胆囊炎的手术效果良好,中转开腹率及术后并发症率低,安全性高。
Objective To investigate the timing of operation for LC in patients with acute cholecystitis in our hospital after PTGD. Methods The clinical data of 143 patients with acute cholecystitis admitted from June 2015 to December 2017 in Yangpu Hospital of Tongji University were collected. According to the time of LC after PTGD, the patients were divided into group A(n=25), group B(n=79), and group C(n=43). LC was performed in group A within2 months after PTGD, LC was performed in group B within 2 to 4 months after PTGD, LC was performed in group C within 4 months after PTGD, and the curative effects of three groups were compared. Results The thickness of gallbladder wall before operation in group B and C was significantly smaller than that in group A. The operation time, ex-haust time, defecation time and hospitalization time in group B were significantly shorter than those in group A and C.The operative blood loss, rate of conversion to open surgery and complications in group B were significantly less than those in group A and C(P<0.05). The levels of IL-2, TNF-a and CRP in group B before LC were significantly lower than those in group A and C, and the levels of IL-4 in group B before LC were significantly higher than those in group A and C(P<0.05). There was no significant difference in preoperative immune function among the three groups(P>0.05). Conclusion LC is effective in the treatment of acute cholecystitis within 2 to 4 months after PTGD. The rate of conversion to open surgery and complications are low, and the safety is high.
Objective To investigate the timing of operation for LC in patients with acute cholecystitis in our hospital after PTGD. Methods The clinical data of 143 patients with acute cholecystitis admitted from June 2015 to December 2017 in Yangpu Hospital of Tongji University were collected. According to the time of LC after PTGD, the patients were divided into group A(n=25), group B(n=79), and group C(n=43). LC was performed in group A within2 months after PTGD, LC was performed in group B within 2 to 4 months after PTGD, LC was performed in group C within 4 months after PTGD, and the curative effects of three groups were compared. Results The thickness of gallbladder wall before operation in group B and C was significantly smaller than that in group A. The operation time, ex-haust time, defecation time and hospitalization time in group B were significantly shorter than those in group A and C.The operative blood loss, rate of conversion to open surgery and complications in group B were significantly less than those in group A and C(P<0.05). The levels of IL-2, TNF-a and CRP in group B before LC were significantly lower than those in group A and C, and the levels of IL-4 in group B before LC were significantly higher than those in group A and C(P<0.05). There was no significant difference in preoperative immune function among the three groups(P>0.05). Conclusion LC is effective in the treatment of acute cholecystitis within 2 to 4 months after PTGD. The rate of conversion to open surgery and complications are low, and the safety is high.
引文
[1]胡军,胡汉卿,郑军.高危急性胆囊炎经皮经肝胆囊穿刺引流术后胆囊切除时机探讨[J].现代仪器与医疗,2018,24(3):30-31,74.
[2]祁亚斌,金雷,雷凯,等.急性胆囊炎行腹腔镜胆囊切除手术时机的前瞻性研究[J].肝胆胰外科杂志,2018,30(4):332-334.
[3]黄琦,周远航,廖芝伟,等.急性胆囊炎腹腔镜胆囊切除术成功的影响因素和手术时机的选择[J].上海医学,2018,41(6):359-362.
[4]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.
[5]张有前,齐伟,钱小星,等.胆总管结石合并胆囊结石行ERCP术后进行腹腔镜胆囊切除手术时机选择[J].肝胆外科杂志,2018,26(2):105-107.
[6]陈晟.实施腹腔镜胆囊切除术治疗急性胆囊炎患者手术时机选择和临床效果分析[J].实用肝脏病杂志,2018,21(2):303-304.
[7]宋兴超,吴磊,路要武.急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨[J].中国普通外科杂志,2018,27(3):349-354.
[8]赵红光,刘凯,刘亚辉.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[J].临床肝胆病杂志,2017,33(4):705-710.
[2]祁亚斌,金雷,雷凯,等.急性胆囊炎行腹腔镜胆囊切除手术时机的前瞻性研究[J].肝胆胰外科杂志,2018,30(4):332-334.
[3]黄琦,周远航,廖芝伟,等.急性胆囊炎腹腔镜胆囊切除术成功的影响因素和手术时机的选择[J].上海医学,2018,41(6):359-362.
[4]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.
[5]张有前,齐伟,钱小星,等.胆总管结石合并胆囊结石行ERCP术后进行腹腔镜胆囊切除手术时机选择[J].肝胆外科杂志,2018,26(2):105-107.
[6]陈晟.实施腹腔镜胆囊切除术治疗急性胆囊炎患者手术时机选择和临床效果分析[J].实用肝脏病杂志,2018,21(2):303-304.
[7]宋兴超,吴磊,路要武.急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨[J].中国普通外科杂志,2018,27(3):349-354.
[8]赵红光,刘凯,刘亚辉.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[J].临床肝胆病杂志,2017,33(4):705-710.