【摘要】 目的探讨经皮经肝胆囊穿刺引流术(PTGD)联合择期腔镜胆囊切除术(LC)在老年中度急性胆囊炎(AC)中的价值。方法根据患者的病情、意愿及经济情况等将95例患者分为PTGBD+LC组(35例)和LC组(60例)。LC组采用急诊LC治疗。PTGBD+LC组采用PTGD联合择期LC治疗。对比两组的LC围手术期评价指标、细胞免疫功能、体液免疫功能和并发症情况。结果与LC组相比,PTGBD+LC组中转开腹的构成比明显低,LC中失血量明显少,手术时间、LC后引流时间和LC后住院时间明显短(P<0.05)。PTGBD+LC组术后的IgA、IgG、IgM、CD3+、CD4+和CD4+/CD8+值均明显高于LC组(P<0.05)。PTGBD+LC组的并发症总发生率明显低于LC组(P<0.05)。结论 PTGD联合择期LC可明显降低LC的难度和风险,提高LC的效果,加快老年中度AC患者的术后恢复,减轻免疫功能损伤和降低并发症发生率。更多还原

【Abstract】 Objective To investigate the value of percutaneous transhepatic gallbladder drainage(PTGD) combined with elective laparoscopic cholecystectomy(LC) in elderly patients with moderate acute cholecystitis(AC).Methods A total of 95 elderly patients with moderate AC were divided into PTGBD+LC group(35 cases) and LC group(60 cases) according to the patient’s condition,willingness and economic situation.The LC group was treated with emergency LC.The PTGBD+LC group was treated with PTGD combined with selective LC.The perioperative evaluation index of LC,cellular immune function,humoral immune function and complications in the two groups were compared.Results Compared with the LC group,the composition ratio of conversion to open surgery in the PTGBD+LC group "was significantly lower,the blood loss in LC was significantly less,the operation time,drainage time after LC and hospitalization time after LC were significantly shorter(P<0.05 or 0.01).The values of IgA,IgG,IgM,CD3+,CD4+and CD4+/CD8+of the PTGBD+LC group-were significantly higher than those of the LC group(P<0.05).The total incidence of complications of the PTGBD+LC group " was significantly lower than that of the LC group(P<0.05).Conclusion PTGD combined with selective LC can significantly reduce the difficulty and risk of LC,improve the effect of LC,accelerate the recovery of elderly patients with moderate AC,reduce incidence of complications.更多还原