[Emergency cholecystectomy versus percutaneous transhepatic gallbladder drainage followed by delayed cholecystectomy in patients with moderate acute cholecystitis]
- PMID: 29562403
- DOI: 10.3760/cma.j.issn.0376-2491.2018.10.011
[Emergency cholecystectomy versus percutaneous transhepatic gallbladder drainage followed by delayed cholecystectomy in patients with moderate acute cholecystitis]
Abstract
Objective: To analysis the curative effect of emergency cholecystectomy (EC) and percutaneous transhepatic gallbladder drainage (PTGBD) followed by delayed cholecystectomy (DC) on the patients with moderate acute cholecystitis. Methods: The perioperative dataof patients in EC group (n=47) and in PTGBD-DC group (n=49) were compared retrospectively. Results: Compared to PTGBD+ DC group, EC patients had a significantly more postoperative abdominal drainage time [(9.0±12.9) vs (3.4±2.1) days, P=0.041], more postoperative hospital stay after cholecystectomy [(8.2±3.2) vs (5.1±1.8) days, P=0.004], more intraoperative bleeding [(101±125) vs (33±37) ml, P=0.003], more patients of LC conversion to open cholecystectomy (OC) (19.1% vs 4.1%, P=0.021) and more patients of OC(14.9% vs 0, P=0.005). Also, there were higher incidence of respiratory failure(14.8% vs 2.0%, P=0.029), and admission for ICU(21.3% vs 2.0 %, P=0.003). Also, patients of total OC in non-biliary surgeons group were more than that of biliary surgeons group statistically(63.2% vs 14.3 %, P=0.001). Conclusion: PTGBD followed by DC in the treatment of moderate acute cholecystitis was better than EC, especially in patients with complicated comorbidities and in non-biliary surgeons.
目的： 对比分析中度急性胆囊炎急诊胆囊切除术(EC)与经皮经肝胆囊穿刺引流术(PTGBD)联合延期胆囊切除术(DC)的临床疗效。 方法： 回顾性对比分析2013年1月至2017年1月间中国医科大学附属盛京医院收治的96例患者，中度急性胆囊炎急诊胆囊切除术(n＝47)与经皮经肝胆囊穿刺引流术(PTGBD)联合延期胆囊切除术(n＝49)的围手术期相关资料。 结果： EC组比PTGBD＋DC组有更多的术后引流时间[(9.0±12.9)与(3.4±2.1)d，P＝0.041]、术后住院时间[(8.2±3.2)与(5.1±1.8 )d，P＝0.004]、手术失血量[(101±125)与(33±37)ml，P＝0.003]、腹腔镜手术(LC)转开腹率(19.1%与4.1%，P＝0.021)及开腹率(14.9%与0，P＝0.005)。同时，EC组较PTGBD＋DC组有更高的呼吸衰竭发生率(14.8%与2.0%，P＝0.029)及ICU入住率(21.3%与2.0%，P＝0.003)。同时，在术者方面，非胆道专业组的总开腹率(开腹＋LC转开腹)显著高于胆道专业组(63.2%与14.3%，P＝0.001)。 结论： PTGBD联合延期胆囊切除术治疗急性中度急性胆囊炎的疗效确切，临床疗效优于急诊胆囊切除术，是值得推广的治疗方式，尤其适用于合并较多基础疾病的患者及非胆道专业组的医师。.
Keywords: Delayed cholecystectomy; Emergency cholecystectomy; Moderate acute cholecystitis; Percutaneous transhepatic gallbladder drainage.
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