本文選題：經(jīng)皮肝膽囊穿刺引流術　切入點：腹腔鏡膽囊切除手術　出處：《中華醫(yī)院感染學雜志》2017年11期 　論文類型：期刊論文

【摘要】：目的探討經(jīng)皮肝膽囊穿刺引流術(PTGBD)聯(lián)合腹腔鏡膽囊切除手術(LC)治療高危急性膽囊炎患者的臨床效果。方法選取2013年1月-2016年4月在解放軍總醫(yī)院肝膽外科手術治療147例急性危重膽囊炎患者進行回顧性分析,根據(jù)患者LC術前是否接受PTGBD治療分為聯(lián)合組71例、LC組76例,對比兩組患者的圍手術期指標、術后實驗室指標的差異。結果聯(lián)合組術中失血(80.3±18.2)ml、腹腔引流時間(3.5±1.2)d、進食時間(3.0±1.1)d均顯著的低于LC組(116.4±24.6)ml、(4.3±1.5)d、(4.2±1.5)d,差異均有統(tǒng)計學意義(P0.05);兩組患者手術時間、術后住院時間比較差異無統(tǒng)計學意義;聯(lián)合組和LC組患者治療前的體溫、WBC計數(shù)、血清堿性磷酸酶(ALP)、總膽紅素(TBIL)、視覺模擬疼痛評分(VAS)差異均無統(tǒng)計學意義;術后72h,聯(lián)合組白細胞計數(shù)(6.4±1.7)109/L、血清ALP(98.3±11.2)U/L、TBIL(22.7±7.1)μmol/L、VAS評分(1.6±0.8)分均顯著低于LC組患者(8.9±2.5)109/L、(113.8±15.0)U/L、(27.0±8.3)μmol/L、(2.3±1.0)分,差異均有統(tǒng)計學意義(P0.05);聯(lián)合組和LC組患者肺部感染率、切口感染率、中轉(zhuǎn)開腹率比較差異無統(tǒng)計學意義。結論 PTGBD聯(lián)合LC治療高危急性膽囊炎患者較單純的LC手術更有利于患者術后恢復。
[Abstract]:Objective to investigate the clinical effect of percutaneous transhepatic cholecystectomy (PTGBD) combined with laparoscopic cholecystectomy (LC) in the treatment of high risk acute cholecystitis. A retrospective analysis of 147 patients with acute severe cholecystitis was made. According to whether or not the patients received PTGBD before LC, they were divided into two groups: the combined group (71 cases) and the LC group (76 cases). The perioperative indexes of the two groups were compared. Results the blood loss, abdominal drainage time and feeding time in the combined group were significantly lower than those in the LC group (116.4 鹵24.6ml, 4.3 鹵1.5d, 4.2 鹵1.5g / d, P < 0.05), and the time of abdominal drainage was 3.5 鹵1.2g / d, and the feeding time was 3.0 鹵1.1g / d, respectively, which was significantly lower than that in the LC group (4.2 鹵1.5g / d), and the operative time of the two groups was significantly lower than that of the LC group (P < 0.05). There was no significant difference in postoperative hospitalization time, WBC count, serum alkaline phosphatase, total bilirubin TBILN and visual analogue pain score (VASs) in patients with combined group and LC group before treatment. At 72 hours after operation, the white blood cell count of the combined group was significantly lower than that in the LC group (6.4 鹵1.7 鹵1.7 鹵109 / L, ALP(98.3 鹵11.2U / L / L = 22.7 鹵7.1) 渭 mol / L / L and 1.6 鹵0.8), respectively, which was significantly lower than that in the LC group (113.8 鹵2.5109L / L + 15.0U / L = 27.0 鹵8.3u mol / L = 2.3 鹵1.0), and the lung infection rate, incision infection rate, incision infection rate in the combined group and LC group were significantly lower than those in the LC group (27.0 鹵8.3 渭 mol / L = 2.3 鹵1.0), and the lung infection rate, incision infection rate, incision infection rate in the combined group and LC group were significantly lower than those in the LC group. Conclusion PTGBD combined with LC is more beneficial to postoperative recovery in patients with high risk acute cholecystitis than LC alone.
【作者單位】： 解放軍總醫(yī)院急診科;勝利油田中心醫(yī)院急診科;麻城市人民醫(yī)院肝膽外科;
【分類號】：R657.4

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