老年急性结石性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择

摘要

目的 探讨老年急性结石性胆囊炎经皮经肝胆囊穿刺引流术后手术时机的选择.方法 回顾性分析我院自2015年3月～ 2017年3月收治的老年急性结石性胆囊炎患者的临床资料,按经皮经肝胆囊穿刺引流术与腹腔镜胆囊切除术间隔时间将符合纳入与排除标准的患者分为三组,其中经皮经肝胆囊穿刺引流术后2个月内行腹腔镜胆囊切除术患者纳入A组(n=70),经皮经肝胆囊穿刺引流术后2～4个月内行腹腔镜胆囊切除术患者纳入B组(n=60),经皮经肝胆囊穿刺引流术后行腹腔镜胆囊切除术时间＞4个月以上患者纳入C组(n=62),对比三组患者腹腔镜胆囊切除术时中转开腹病例、手术时间、术中失血量、术后腹腔引流导管留置时间、住院时间,并统计腹腔镜胆囊切除术后腹腔出血、胆道损伤、胆漏等并发症发生率.结果 三组急性结石性胆囊炎患者在中转开腹比例、手术时间、术中失血量、腹腔引流导管留置时间、住院时间等一般手术情况上比较,其差异均有统计学意义(P＜0.05),B组中转开腹比例、术中失血量最少、手术时间、腹腔引流导管留置时间、住院时间最短;B组术后并发症发生率仅为6.67％,低于A组的16.67％及C组的10.00％,但对比差异无统计学意义(P＞0.05).结论 老年急性结石性胆囊炎经皮经肝胆囊穿刺引流术后2～4个月内行腹腔镜胆囊切除术或能取得更佳手术获益,不仅能减少术中中转开腹比例,也更利于患者术后康复.%Objective To explore the operation time for elderly patients with acute calculous cholecystitis after percutaneous transhepatic gallbladder drainage.Methods The clinical data of elderly patients with acute calculous cholecystitis who were treated in our hospital from March 2015 to March 2017 were analyzed retrospectively.The patients were divided into three groups according to the interval between percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy.Patients treated by laparoscopic cholecystectomy within 2 months after percutaneous transhepatic gallbladder drainage were included into group A (n =70),patients treated by laparoscopic cholecystectomy in 2 ～ 4 months after percutaneous transhepatic gallbladder drainage were included into group B (n =60),and patients treated by laparoscopic cholecystectomy at longer than 4 months after percutaneous transhepatic gallbladder drainage were included into group C (n =62).Cases transferred to open operation in laparoscopic cholecystectomy,operation time,intraoperative blood loss,postoperative peritoneal drainage catheter indwelling time and the length of hospital stay were compared between groups.The incidence rates of intra-abdominal hemorrhage,bile duct injury and bile leakage were statistically analyzed.Results There were significant differences among the three groups in the proportion of conversion to open operation,operation time,intraoperative blood loss,peritoneal drainage catheter indwelling time and the length of hospital stay (P ＜ 0.05).The percentage of conversion to open operation and the intraoperative blood loss were the lowest / least,the operative time,peritoneal drainage catheter indwelling time and the length of hospital stay were the shortest in group B.The incidence of postoperative complications in group B (6.67％) was lower than that in group A (16.67％) and C group (10.00％),without statistically significant difference between groups (P ＞ 0.05).Conclusion The effects of laparoscopic cholecystectomy carried out in elderly patients with acute calculous cholecystitis in 2 ～ 4 months after percutaneous transhepatic gallbladder drainage are relatively better.It not only can reduce the proportion of conversion to open operation,but also facilitate postoperative rehabilitation of patients.