急性胆囊炎的外科治疗方法比较分析

摘要

目的 比较和分析急性胆囊炎的外科治疗方法.方法 回顾性分析我院近3年收治的264例急性胆囊炎患者,分为4组:择期LC组(A组):98例,经药物保守治疗后择期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC);急诊LC组(B组):102例,急诊行LC;PTGD+ LC组(C组):36例,先行彩超定位下经皮肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGD),再行LC;单纯PTGD组(D组):28例,单纯行PTGD.将4组患者的一般和住院情况进行两两比较.将A、B、C三组的术中和术后情况进行两两比较.结果 年龄A、B二组比较差异无统计学意义(q =2.75,P＞0.05),其他组别两两比较,差异有统计学意义(qAB=2.75,qAc=6.85,qAD=4.04,qBc=5.64,qBD=3.26,qcD=4.75,P＜0.05);总住院天数:A组与C组,B组与D组两两比较差异无统计学意义(qAC=1.76,qBD=1.21,P＞0.05),余两两比较,差异有统计学意义(qAB=5.72,qAD=3.62,qBC =7.25,qCD =4.38,P＜0.05).A、B、C三组手术时间:A、B二组比较差异无统计学意义(qAB=1.86,P＞0.05),C组和A、B二组比较差异有统计学意义(qAc=8.25,qBC=4.26,P＜0.05);术中出血量(qAB=1.68,qAC=3.05,qBc=1.99,P＞0.05)、中转开腹率(P＞0.05)、术后并发症(JP＞0.05):三组两两比较差异无统计学意义.结论 对于无明显手术禁忌证的急性胆囊炎,急诊行LC是可行且安全的;对于暂不宜手术患者,可先行PTGD,再考虑决定性治疗.%Objective To compare and analyze methods of surgical therapy about acute cholecystitis.Methods During recent 3 years 264 patients of acute cholecystitis were devided into group A (98 cases) undergoing elected LC,group B (102 cases) undergoing emergency LC,group C (36 cases) treated by percutaneous transhepatic gallbladder drainage (PTGD) followed by LC,and group D (28 cases) receiving PTGD only.Results Age differences weren't significant between group A and B (q =2.75,P ＞ 0.05),but significant between other groups (qAB =2.75,qAC =6.85,qAD =4.04,qBC =5.64,qBD =3.26,qCo =4.75,P ＜0.05).Difference weren't significant in total hospital stay between group A and C and between B and D(qAc =1.76,qBD =1.21,P ＞0.05),while that was significant between any other two groups (qAB =5.72,qAD =3.62,qBc =7.25,qcD =4.38,P ＜ 0.05).Operation time wasn't different between group A and B (qAB =1.86,P ＞ 0.05),it was significantly different between group C,A and B (qAc =8.25,qBC =4.26,P ＜ 0.05).Intraoperative blood loss (qAB =1.68,qAc =3.05,qBc =1.99,P ＞ 0.05),conversion rate (P ＞ 0.05) and postoperative complication rate (P ＞ 0.05) were similar between group A,B and C.Conclusions It was safe and feasible for emergency LC in selected cases of acute cholecystitis.In poor risk patients,PTGD was advised to tide the patients over and then followed by LC.