探讨急性重症胆囊炎行微创治疗手术时机的研究

doi:10.3969/j.issn.1006-6233.2022.11.011

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Abstract Objective: To investigate the timing of minimally invasive surgery for acute severe cholecystitis.Methods: Fifty five patients with acute severe cholecystitis who visited our hospital from January 2018 to December 2021 were selected as the study subjects, and the patients were divided into LC group (25 cases) and PTGD combined with LC group (30 cases) according to the different surgical timing of laparoscopic cholecystectomy (LC). The LC group all underwent LC, and the PTGD combined with LC group received LC before 5-8 weeks after initial ultrasound-guided percutaneous transhepatic cholecystocentesis catheter drainage (PTGD). Patient related clinical indicators were compared between the two groups. Results: there were no significant differences in age, gender, body mass index (BMI), and society of anesthesiologists (ASA) grade between the two groups (P>0.05), and the gallbladder wall thickness measured by preoperative transabdominal color ultrasound in the LC group was greater than that in the PTGD combined with LC group (P<0.001). Compared with the LC group, the PTGD combined with LC group had a shorter operation time, less intraoperative blood loss and intraoperative adhesion of the gallbladder trigone, a shorter time for the return of white blood cells and body temperature to normal, the time for the removal of abdominal drainage tube and the time for the first postoperative flatus (P<0.05); PTGD combined with LC group had postoperative alanine transaminase γ- The overall incidences of glutamyltransferase, C-reactive protein, procalcitonin, and postoperative complications were lower in the LC group, and the postoperative prealbumin and superoxide dismutase levels were higher in the LC group (all P<0.001). The incidence ratio of conversion to open was 0.00%: 3.33% in LC group and PTGD combined with LC group patients, and there was no statistical difference between groups (P>0.05). Conclusions: in patients with acute severe cholecystitis, LC performed after ultrasound-guided PTGD is a safe and feasible treatment to relieve the degree of intraoperative adhesion, promote early and rapid postoperative recovery, attenuate the inflammatory response of the gallbladder before and during surgery, improve liver function status, and also reduce the incidence of postoperative complications.

Key words： Percutaneous transhepatic cholecystectomy and catheter drainage Laparoscopic cholecystectomy Acute severe cholecystitis

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.11.011 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I11/1816

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