【摘要】 目的探讨老年急性胆囊炎患者在B超引导下经皮经肝行胆囊穿刺引流(PTGD)后不同时期行腹腔镜下胆囊切除术(LC)的效果分析。方法回顾性分析2010年1月至2018年1月台州市立医院肝胆外科收治的老年急性胆囊炎PTGD后分期治疗的患者93例,根据择期手术时间分为A组:60 d内(42例),B组:60及60 d以上(51例),分析比较两组患者手术时间、术中出血量、中转开腹率、术后肛门排气时间、术后第1天疼痛评分、住院时间、住院费用、术后并发症发生情况。结果两组患者手术经过顺利,无患者死亡。B组手术时间、术中出血量、住院时间及住院费用均优于A组(均P<0.05),而中转开腹率、术后肛门排气时间、术后第1天疼痛评分两组间差异均无统计学意义(均P>0.05)。两组间单个并发症比较差异均无统计学意义(均P>0.05),但总并发症发生率A组大于B组(P<0.05)。结论对于老年急性胆囊炎患者行PTGD后60 d及60 d以上择期行LC治疗相对近期更能取得良好效果。更多还原

【Abstract】 Objective To compare the efficacy of laparoscopic cholecystectomy(LC) in elderly patients with acute cholecystitis at different periods after B-ultrasound-guided percutaneous transhepatic gallbladder puncture and drainage(PTGD). Methods Clinical data of 93 elderly patients with acute cholecystitis admitted to the Department of Hepatobiliary Surgery, Taizhou Municipal Hospital between January 2010 and January 2018 were retrospectively analyzed. Patients received PTGD at admission, 42 patients underwent LC within 60 d(group A) after PTGD and 51 patients underwent LC ≥60 d after PTGD(group B). The operative time, intraoperative blood loss, conversion to open surgery, postoperative flatus time, pain score on postoperative d 1, length of hospital stay, hospital costs, and postoperative complications were compared between the two groups. Results The procedures of patients in this study group were all uneventful. Group B was superior to group A in terms of operative time, intraoperative blood loss, length of hospital stay, and hospital costs(all P<0.05), whereas no significant differences were found in the conversion to open surgery, postoperative flatus time, or postoperative pain score on d 1(all P >0.05).There were no significant differences in the incidence of single complications between the two groups(all P >0.05), but the total complication rate in group A was greater than that in group B(P<0.05). Conclusion Elective LC 60 d or longer following PTGD in elderly patients with acute cholecystitis has relatively better outcomes.更多还原