【摘要】 目的探讨急性重症胆囊炎腹腔镜胆囊切除术前行PTGD的有效性及潜在优势。方法对5年间135例因急性重症胆囊炎行LC的患者进行回顾性分析。病人分为3组:一组为不行PTGD直接行LC的患者(n=45);二组为PTGD后1周行LC的患者(n=38);三组为PTGD后1个月行LC的患者(n=52)。分析各组临床资料,评价PTBD效果,比较各组LC中转开腹率、并发症发生率以及手术效果等。结果二组和三组PTGD术后并发症、病情改善效果没有显著差异(P>0.05)。LC术后中转开腹率比较:一组10例(22.2%),二组7例(18.4%),三组有2例(3.8%),三组与一组和二组比较差异均有显著意义(P<0.05)。手术时间比较:一组95.7±30.5min,二组76.7±29.8min,三组为60.4±15.6min,三组与一组和二组相比差异均有显著意义(P<0.05)。术后并发症比较:一组8例(17.7%),二组5例(13.2%),三组2例(3.8%),三组与一组和二组相比均有显著差异(P<0.05)。结论急性重症胆囊炎PTGD后延期行LC是安全有效的,可以降低中转开腹率及并发症发生率,延期手术时间以1个月较为理想。更多还原

【Abstract】 Objective To investigate the effect and potential advantages on percutaneous transhepatic gallblader drainage (PTGD) performed before laparoscopic cholecystectomy (LC) in acute severe cholecyctitis. Methods One hundred and thirty five patients with acute severe cholecystitis who received LC were retrospectively analyzed from October 2004 to October 2009. The patients were divided into 3 groups: group 1, patients who underwent LC without preoperative PTGD(n=45); group 2, patients who underwent LC one week after PTGD(n=38); group 3, patients who underwent an LC one month after PTGD(n=52).The clinical data were analyzed, and the effect of PTGD was evaluated. The conversion rate to open cholecystectomy,the postoperative complication rate and the operative effect after LC in each group were compared. Results The complications and clinical improvement were no significant difference between group 2 and group 3(P>0.05). The conversion rates of LC were 22.2% (10 cases) in group 1, 18.4% (7 cases) in group 2 and 3.8% (2 cases) in group 3, which was lower in group 3 than in group 1 and group 2 (P<0.05). The operation time of LC was 95.7±30.5min in group 1, 76.7±29.8min in group 2 and 60.4±15.6min in group 3, and it was the shortest one in group 3 (P<0.05). The postoperative complicaion rates were 17.7% (8 cases) in group 1, 13.2% (5 cases) in group 2 and 3.8% (2 cases) in group 3, which was also the lowest in group 3 (P<0.05). Conclusion Delayed LC after PTGD in acute severe cholecystitis is a safe and effecive treatment. It would lower the conversion to open surgery and complication rates. One month was appropriate for the time between PTGD and LC.更多还原