经皮经肝胆囊穿刺置管引流术联合LC治疗≥65岁老年中度急性胆囊炎的效果研究

doi:10.3969/j.issn.1009-976X.2025.01.004

摘要/Abstract

摘要： 目的研究经皮经肝胆囊穿刺置管引流术（PTGBD）联合腹腔镜胆囊切除术（LC）与直接LC在≥65岁老年中度急性胆囊炎（AC）中的治疗效果。方法回顾性分析2020年11月至2023年11月我院收治的97例≥65岁老年中度急性胆囊炎患者的临床数据。根据手术方式不同分为PTGBD+LC组（41例）和LC组（56例）。比较两组的术前一般情况、术中出血量、手术时间、中转开腹率、首次排气时间、术后疼痛程度、腹腔引流时间、术后住院时间、住院总费用、总住院时间以及手术并发症。结果 PTGBD+LC组ASA分级>Ⅱ级比例高于LC组（P<0.05）,PTGBD+LC组术中出血量少于LC组,手术时间、首次排气时间、术后住院时间短于LC组,术后24 h VAS评分低于LC组,但是住院总费用和总住院时间均大于LC组（P<0.05）。PTGBD+LC组中转开腹0例,LC组中转开腹4例,但两组中转开腹率比较差异无统计学意义。PTGBD+LC组发生并发症5例（12.2%）,LC组发生并发症17例（30.4%）,两组并发症发生率比较有统计学差异（P<0.05）。结论 PTGBD联合LC可明显降低手术难度和风险,提高LC的安全性,加快术后康复,对≥65岁老年中度急性胆囊炎患者是一种值得考虑的选择。

关键词: 经皮经肝胆囊穿刺置管引流术, 腹腔镜胆囊切除术, 急性胆囊炎

Abstract: Objective To investigate the effect of percutaneous transhepatic gallbladder drainage （PTGBD） combined with laparoscopic cholecystectomy （LC） versus direct LC in patients ≥65 years old with moderate acute cholecystitis. Methods The clinical data of 97 patients ≥65 years old with moderate acute cholecystitis admitted to our hospital from November 2020 to November 2023 were analyzed retrospectively. They were divided into PTGBD+LC group （41 cases） and LC group （56 cases） according to the different surgical procedures. The preoperative general condition, intraoperative bleeding, operation time, intra-operative transit open rate, time of first exhaustion, postoperative pain level, postoperative abdominal drain time, postoperative hospitalization time, total hospitalization cost, total hospitalization time and surgical complications were compared between the two groups. Results The proportion of ASA grade >Ⅱ in PTGBD+LC group was higher than that in LC group （P<0.05）. Intraoperative bleeding in PTGBD+LC group was less than that in LC group. The operation time, time of the first exhaustionand time of the postoperative hospital stay were shorter than that in LC group.The postoperative VAS score of 24 h was lower than that in LC group, but the total hospitalization cost and total hospital stay were greater than those in LC group （P<0.05）. There was no statistically significant difference in the intra-operative transit open rate between two groups, with 0 cases in PTGBD+LC group and 4 casesin LC group. There was a statistically significant difference in the comparison of the rate of complications between the two groups （P<0.05）, with 5 cases（12.2%） of complications in PTGBD+LC group and 17 cases （30.4%） in LC group. Conclusion PTGBD combined with LC can significantly reduce the difficulty and risk of surgery, improve the safety of LC, and accelerate postoperative recovery, making it a worthwhile option to consider for patients ≥65 years old with moderate acute cholecystitis.

Key words: percutaneous transhepatic gallbladder drainage, laparoscopic cholecystectomy, acute cholecystitis

中图分类号:

R657.4+1

庄洪财, 罗丹丹, 何超. 经皮经肝胆囊穿刺置管引流术联合LC治疗≥65岁老年中度急性胆囊炎的效果研究[J]. 岭南现代临床外科, 2025, 25(01): 19-23.

ZHUANG Hong-cai, LUO Dan-dan, HE Chao. Effect of percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy in patients ≥65 years old with moderate acute cholecystitis[J]. Lingnan Modern Clinics In Surgery, 2025, 25(01): 19-23.

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