Application of PTGD Combined with Elective LC in the Treatment of Cholecystolithiasis with Acute Onset of Chronic Cholecystitis
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摘要:
目的 探讨B超引导下经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage，PTGD）联合择期腹腔镜胆囊切除术（laparoscopiccholecystectomy，LC）治疗胆囊结石伴慢性胆囊炎急性发作的疗效。 方法 回顾性分析2018年1月至2021年9月昆明医科大学第二附属医院肝胆胰外科二病区以及西双版纳傣族自治州人民医院普外科收治的胆囊结石伴慢性胆囊炎急性发作的患者61例，急性期均接受PTGD，其中40例患者再次入院而后行择期LC。对比PTGD前及LC前患者临床表现、实验室检查及影像学差异，并分析PTGD及LC相关并发症及术后情况。 结果 40例患者再次返院行择期LC，与PTGD前比较，患者的腹痛、发热等临床表现好转或消失；白细胞计数下降，谷丙转氨酶、谷草转氨酶下降，差异有统计学意义（P < 0.05）；腹部B超提示：胆囊壁厚度变薄、胆囊最长径缩短，差异有统计学意义（P < 0.05）；40例患者接受LC均在腹腔镜下完成手术，无中转开腹，无胆道损伤，无并发症，均治愈出院。 结论 PTGD联合择期LC治疗胆囊结石伴慢性胆囊炎急性发作疗效确切，可有避免胆道损伤，降低LC中转开腹率，确保患者安全。 -
关键词:
- 胆囊结石 /
- 慢性胆囊炎急性发作 /
- 经皮经肝胆囊穿刺引流术 /
- 腹腔镜胆囊切除术 /
- 疗效
Abstract:Objective To investigate the efficacy of ultrasound-guided percutaneous transhepatic cholecystectomy combined with elective laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with acute onset of chronic cholecystitis. Methods 61 patients with cholecystolithiasis complicated with acute onset of chronic cholecystitis admitted to The 2nd Heptatopancreatobiliary Surgery Department of The Second Affiliated Hospital of Kunming Medical University and The General Surgery Department of Xishuangbanna Dai Autonomous Prefecture People’ s Hospital from January 2018 to September 2021 were retrospectively analyzed. All patients received PTGD in the acute stage, and 40 of them received elective LC after readmission. The clinical manifestations, laboratory examinations and imaging differences between patients before PTGD and before LC were compared, and PTGD and LC related complications and postoperative conditions were analyzed. Results 40 patients returned to the hospital again for elective LC. Compared with before PTGD, the clinical manifestations of the patients, such as abdominal pain and fever, were improved or disappeared. WBC count decreased, alanine aminotransferase and aspartate aminotransferase decreased, and the difference was statistically significant （P < 0.05）. Abdominal ultrasound showed that the gallbladder wall thickness was thinner and the longest diameter of the gallbladder was shortened, with statistical significance （P < 0.05）. All the 40 patients who received LC were operated under laparoscope without conversion to laparotomy, biliary tract injury or complications, and all were cured and discharged from hospital. Conclusion PTGD combined with elective LC is effective in the treatment of cholecystolithiasis with acute attack of chronic cholecystitis, which can avoid biliary tract injury and reduce the conversion of LC to laparotomy. -
表 1 40例胆囊结石伴慢性胆囊炎急性发作患者PTGD前后临床症状对比[n（%）]
Table 1. Comparison of clinical symptoms between 40 cases of acute onset of chronic cholecystitis before and after PTGD procedure [n（%）]
组别 n 腹痛 发热 胆囊结石伴慢性胆囊炎急性发作
第1次入院，PTGD前40 40（100.0） 26（65.0） 第2次入院，PTGD后 40 2（5.0） 0（0.0） χ2 72.381 38.519 p 0* 0* *P < 0.05。 
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表 2 40例胆囊结石伴慢性胆囊炎急性发作PTGD前后实验室检查指标比较（
$\bar x \pm s $ ）Table 2. Comparison of laboratory indicators (WBC, ALT, AST) between 40 cases of acute onset of chronic cholecystitis before and after PTGD procedure （
$\bar x \pm s $ ）组别 n WBC（×109/L） ALT（U/L） AST（U/L） 胆囊结石伴慢性胆囊炎急性发作 第1次入院，PTGD前 40 13.12 ± 6.40 36.30 ± 15.98 31.65 ± 13.22 第2次入院，PTGD后 40 7.95 ± 1.76 29.43 ± 10.87 25.80 ± 12.71 t 5.821 2.408 2.210 P 0.000* 0.021* 0.033* *P < 0.05。
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表 3 40例胆囊结石伴慢性胆囊炎急性发作患者PTGD前后胆囊壁厚度、最大径对比（
$\bar x \pm s $ ）Table 3. Comparison of the gallbladder wall and the longest diameter of the gallbladder under the Abdominal ultrasound between 40 cases of acute onset of chronic cholecystitis before and after PTGD procedure （
$\bar x \pm s $ ）组别 n 胆囊壁厚度（cm） 胆囊最长径（cm） 胆囊结石伴慢性胆囊炎急性发作 第1次入院，PTGD前 40 0.54 ± 0.21 10.46 ± 2.11 第2次入院，PTGD后 40 0.34 ± 0.11 5.97 ± 1.64 t 6.787 11.828 p 0.000* 0.000* *P < 0.05。
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