1 成都中医药大学附属医院普外科，成都 610000
目的：比较经皮经肝胆囊穿刺置管引流术(percutaneous transhepatic gallbladder drainage，PTGD)后一期腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)与二期LC治疗急性胆囊炎的临床效果。方法：回顾性采集2017年2月至2019年11月成都中医药大学附属医院收治的105例急性胆囊炎患者，按PTGD术后LC治疗时间分为早期组(n=58，PTGD术后1周内行LC)与延期组(n=47，PTGD术后1~2个月内行LC)，比较两组手术一般情况(手术时间、术中出血量、中转开腹情况、术后肛门首次排气时间、住院时间)，测定两组LC手术前后肝功能[谷草转氨酶 (AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)]及炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)、降钙素原(PCT)]水平的变化，统计两组术后3个月内近期并发症发生情况。结果：两组手术时间、术中出血量及中转开腹所占比例比较差异无统计学意义(P>0.05)，早期组术后肛门首次排气时间及住院时间短于延期组(P<0.05)；LC术后24 h，72 h，两组AST、ALT、TBIL、GGT及ALP均降低，早期组术后24 h，72 h AST，ALT，TBIL，GGT，ALP均低于延期组(P<0.05)；LC术后两组hs-CRP，TNF-α，IL-6，IL-10，PCT均下降，早期组以上各炎症因子水平低于延期组(P<0.05)；两组近期手术并发症发生率比较差异无统计学意义(P>0.05)。结论：PTGD术后早期行LC较延期行LC更利于控制胆囊炎症，改善肝功能和胆囊炎症状，促进患者术后恢复，安全可行。
Comparative analysis of clinical effect between LC and two-stage LC in the treatment of acute cholecystitis after PTGD
CorrespondingAuthor: FU Ting
This work was supported by the Scientific Research Project of Sichuan Science and Technology Department (2017SZ00812), China.
Objective: To compare the clinical value between one-stage laparoscopic cholecystectomy (LC) and two-stage LC in the treatment of acute cholecystitis after percutaneous transhepatic gallbladder drainage (PTGD). Methods: A total of 105 patients with acute cholecystitis who were admitted to the hospital between February 2017 and November 2019 were selected and divided into the early group (58 cases treated with LC within 1 week after PTGD extubation) and the delayed group (47 cases treated with LC within 1~2 months after PTGD extubation). The general conditions of operation (operation time, intraoperative blood loss, conversion to laparotomy, postoperative first anal exhaust time, hospital stay) were compared between the two groups. The changes in liver function [aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), γ-glutamyl transferase (GGT), alkaline phosphatase (ALP)] and inflammatory factors [high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), procalcitonin (PCT)] before and after LC were determined. The incidence of complications within 3 months after surgery was statistically analyzed. Results: There was no statistically significant difference in the operation time, intraoperative blood loss or the proportion of conversion to laparotomy between the two groups (P>0.05). The postoperative anal exhaust time and hospital stay of the early group were shorter than those of the delayed group (P<0.05) At 24 and 72 h after LC, the AST, ALT, TBIL, GGT and ALP were decreased, and the above indexes in the early group were lower than those in the delayed group (P<0.05). After LC, the hs-CRP, TNF-α, IL-6, IL-10 and PCT were decreased, and the levels of above inflammatory factors in the early group were lower than those in the delayed group (P<0.05). There was no statistically significant difference in the incidence of short-term complications between the two groups (P>0.05). Conclusion: Early LC after PTGD is more conducive to controlling gallbladder inflammation, improving liver function, relieving symptoms of cholecystitis, and promoting postoperative recovery. It is safe and feasible.
acute cholecystitis; laparoscopic cholecystectomy; percutaneous transhepatic gallbladder drainage; early surgery; delayed surgery