UG-PTGD联合LC术治疗急性结石梗阻性胆囊炎患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.03.035

摘要/Abstract

摘要： 目的探讨超声引导下经皮经肝胆囊穿刺引流术(UG-PTGD)联合腹腔镜胆囊切除术(LC)治疗急性结石梗阻性胆囊炎(ACOC)患者的疗效。方法 2020年5月～2024年5月我院诊治的ACOC患者109例,被随机分为对照组54例和观察组55例,分别采用LC手术或在UG-PTGD手术后择期行LC治疗。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和C反应蛋白(CRP)水平。结果观察组胆囊切除手术时间、术中出血量、术后引流量、肛门排气、拔管和住院日分别为(54.5±8.1)min、(33.8±7.9)mL、(18.5±2.9)mL、(21.5±4.2)h、(3.3±0.6)d和(4.5±1.5)d,均显著小于或短于对照组【分别为(72.6±11.4)min、(44.1±6.7)mL、(26.9±4.2)mL、(27.4±3.9)h、(4.8±0.7)d和(10.6±2.9)d,P＜0.05】;术后,观察组血清AST和ALT水平均显著低于对照组(P＜0.05);观察组血清TNF-α、IL-6和CRP水平分别为(32.2±11.4)ng/mL、(116.7±12.3)pg/mL和(25.8±5.2)mg/L,均显著低于对照组【分别为(39.6±12.7)ng/mL、(127.1±19.2)pg/mL和(46.7±8.1)mg/L,P＜0.05】;观察组并发症发生率为9.1%,显著低于对照组的24.1%(P＜0.05)。结论采取UG-PTGD紧急处理,再择机施行LC治疗ACOC患者可行、有利、有效,不失为一种较好的临床选择。

关键词: 急性结石梗阻性胆囊炎, 超声引导下经皮经肝胆囊穿刺引流术, 腹腔镜胆囊切除术, 治疗

Abstract: Objective The aim of this study was to investigate selective laparoscopic cholecystectomy (LC) after ultrasound-guided percutaneous transhepatic gallbladder puncture drainage (UG-PTGD) in treatment of patients with acute calculous obstructive cholecystitis (ACOC). Methods A total of 109 patients with ACOC were encountered in our hospital between May 2020 and May 2024, and were randomly assigned to receive LC (control, n=54) or selective LC after UG-PTGD (observation, n=55). Serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected by ELISA. Results Operation time, intraoperative blood loss, postoperative drainage volume, anal exhaust time, extubation time and hospital stay in the observation group were (54.5±8.1)min, (33.8±7.9)mL,(18.5±2.9)mL,(21.5±4.2)h, (3.3±0.6)d and (4.5±1.5)d, all much less or shorter than [(72.6±11.4)min,(44.1±6.7)mL,(26.9±4.2)mL,(27.4±3.9)h,(4.8±0.7)d and (10.6±2.9)d, respectively, P＜0.05] in the control; post-operationally, serum AST and ALT levels were much lower than in the control (P＜0.05); serum TNF-α, IL-6 and CRP levels were (32.2±11.4)ng/mL, (116.7±12.3)pg/mL and (25.8±5.2)mg/L, all significantly lower than [(39.6±12.7)ng/mL, (127.1±19.2)pg/mL and (46.7±8.1)mg/L, respectively, P＜0.05] in the control; incidence of complications was 9.1%, much lower than 24.1%(P＜0.05) in the control group. Conclusion Emergent management by UG-PTGD, and thereafter selective LC in the treatment of patients with ACOC were safe, efficacious, which might be an alternative option in this clinical scenario.

Key words: Acute calculous obstructive cholecystitis, Ultrasound-guided percutaneous transhepatic gallbladder puncture drainage, Laparoscopic cholecystectomy, Therapy

晏化军, 陈兴云, 马兵, 杨冲. UG-PTGD联合LC术治疗急性结石梗阻性胆囊炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 458-461.

Yan Huajun, Chen Xingyun, Ma Bing, et al. Ultrasound-guided percutaneous transhepatic gallbladder puncture drainage and subsequent selective laparoscopic cholecystectomy in treatment of patients with acute calculous obstructive cholecystitis[J]. Journal of Practical Hepatology, 2025, 28(3): 458-461.

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UG-PTGD联合LC术治疗急性结石梗阻性胆囊炎患者疗效研究^*

Ultrasound-guided percutaneous transhepatic gallbladder puncture drainage and subsequent selective laparoscopic cholecystectomy in treatment of patients with acute calculous obstructive cholecystitis

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