【摘要】 目的:探讨胆囊穿刺置管造口引流术在老年急性化脓坏疽性胆囊炎患者治疗中的临床价值。方法:选取2016年1月-2018年12月本院收治的急性化脓性坏疽性胆囊炎老年患者52例,按随机数字表法分为对照组与观察组,各26例。对照组行腹腔镜下胆囊切除术治疗,观察组行胆囊穿刺置管造口引流术结合腹腔镜胆囊切除术治疗。比较两组治疗效果、围手术期指标、炎性因子、免疫功能及术后并发症情况。结果:观察组治疗总有效率高于对照组(P<0.05);观察组手术时间、体温、凝血功能、血压、白细胞计数恢复时间及总住院时间均短于对照组,且术中出血量低于对照组,差异均有统计学意义(P<0.05);观察组术后1周肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及C反应蛋白(CRP)水平均低于对照组(P<0.05);观察组术后1周CD3~+、CD4~+与CD4~+/CD8~+水平均高于对照组(P<0.05);观察组术后并发症发生率低于对照组(P<0.05)。结论:腹腔镜胆囊切除术前行胆囊穿刺置管造口引流术治疗急性化脓坏疽性胆囊炎老年患者可提高疗效,促进术后恢复,减轻炎症反应,提高免疫功能,降低术后并发症的发生。更多还原

【Abstract】 Objective:To explore the clinical value of percutaneous transhepatic gallbladder drainage in the treatment of elderly patients with acute pyogenic gangrenous cholecystitis.Method:A total of 52 elderly patients with acute pyogenic gangrene cholecystitis admitted to our hospital from January 2016 to December 2018 were selected.They were divided into control group and observation group according to the random number table,26 cases in each group.The control group was treated with laparoscopic cholecystectomy,while the observation group was treated with percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy.The therapeutic effect,perioperative index,inflammatory factor,immune function and postoperative complications were compared between the two groups.Result:The total effective rate in the observation group was higher than that in the control group (P<0.05).The surgery time,temperature,coagulation function,blood pressure,white blood cell count recovery time and total hospitalization time of the observation group were lower than those of the control group,and the intraoperative blood loss was lower than that of the control group,the differences were statistically significant (P<0.05).The levels of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),and C-reactive protein (CRP) at 1 week after surgery in the observation group were lower than those in the control group (P<0.05).The levels of CD3~+,CD4~+ and CD4~+/CD8~+ at 1 week after surgery in the observation group were higher than those in the control group (P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group (P<0.05).Conclusion:Before laparoscopic cholecystectomy,percutaneous transhepatic gallbladder drainage in the treatment of elderly patients with acute pyogenic gangrenotic cholecystitis can improve the therapeutic effect,promote postoperative recovery,reduce inflammatory response,improve immune function and reduce postoperative complications.更多还原