PTGD序贯保留胆囊动脉主干的LC术治疗急性胆囊炎患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.03.036

摘要/Abstract

摘要： 目的分析比较经皮经肝胆囊穿刺引流术(PTGD)序贯保留胆囊动脉主干的腹腔镜胆囊切除术(LC)治疗急性胆囊炎(AC)患者的效果及对术后并发症发生的影响。方法 2020年10月～2023年9月我院收治的206例AC患者,采用随机数字表法将患者分为对照组103例和观察组103例,分别采用PTGD联合常规LC术或PTGD序贯保留胆囊动脉主干的LC术治疗。采用ELISA法检测血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)、血浆皮质醇(Cor)和去甲肾上腺素(NE)水平。结果观察组手术时间为(56.5±7.2)min,显著长于对照组【(44.3±10.4)min,P＜0.05】,而术中出血量为(16.5±3.2)ml,显著少于对照组【(67.4±14.5)ml,P＜0.05】;在手术前后,两组血生化指标无显著性差异(P>0.05);在术后5 d,观察组血清CRP、IL-6、TNF-α和Cor水平分别为(18.5±2.3)mg/L、(14.5±12.3)mmol/L、(12.1±6.1)mmol/L和(56.5±17.1)ng/mL,均显著低于对照组【分别为(27.4±25.4)mg/L、(29.6±18.5)mmol/L、(25.1±8.1)m mol/L和(79.4±30.2)ng/mL,P＜0.05】;术后,观察组切口感染、胆漏和胆管损伤等并发症发生率与对照组比,无显著性差异(4.9%对5.8%,P>0.05)。结论采用PTGD序贯保留胆囊动脉主干的LC术治疗AC患者可有效减少术中出血量,值得临床研究。

关键词: 急性胆囊炎, 经皮经肝胆囊穿刺引流术, 保留胆囊动脉主干, 腹腔镜胆囊切除术, 治疗

Abstract: Objective The purpose of this study was to observe the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) and sequential laparoscopic cholecystectomy (LC) with preservation of main cystic artery in the treatment of patients with acute cholecystitis (AC). Methods 206 patients with AC were encountered in our hospital between October 2020 and September 2023, and were randomly divided into control (n=103) and observation group (n=103). The patients in the control group underwent PTGD and sequential conventional LC, and those in the observation group underwent PTGD and sequential LC with preservation of main cystic artery. Serum C-reactive protein (CRP), interleukin-6 (IL-6) , tumor necrosis factor (TNF-α), plasma cortisol (Cor) and norepinephrine (NE) levels were measured by ELISA. Results The operation time in the observation group was (56.5±7.2)min, much longer than [(44.3±10.4)min,P＜0.05], while the intraoperative blood loss was (16.5±3.2)ml, much less than [(67.4±14.5)ml, P＜0.05] in the control; there were no significant differences as respect to serum liver function tests before and after the operation between the two groups (P>0.05); five days after operation, serum CRP, IL-6, TNF-α and Cor levels in the observation were (18.5±2.3)mg/L, (14.5±12.3)mmol/L, (12.1±6.1)mmol/L and (56.5±17.1)ng/mL, all significantly lower than [(27.4±25.4)mg/L, (29.6±18.5)mmol/L, (25.1±8.1)m mol/L and (79.4±30.2)ng/mL, respectively, P＜0.05] in the control group; post-operationally, there was no significant difference respect to complications, such as incision infection, bile leakage and biliary injuries, between the two groups (4.9% vs. 5.8%, P>0.05). Conclusion The PTGD and sequential LC with preservation of main cystic artery could effectively reduce the intraoperative blood loss, and warrants further clinical investigation.

Key words: Acute cholecystitis, Percutaneous transhepatic gallbladder drainage, Preservation of main cystic artery, Laparoscopic cholecystectomy, Therapy

冯淞, 李连杰, 程波. PTGD序贯保留胆囊动脉主干的LC术治疗急性胆囊炎患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 462-465.

Feng Song, Li lianjie, Cheng Bo. Percutaneous transhepatic gallbladder drainage and sequential laparoscopic cholecystectomy with preservation of main cystic artery in the treatment of patients with acute cholecystitis[J]. Journal of Practical Hepatology, 2025, 28(3): 462-465.

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PTGD序贯保留胆囊动脉主干的LC术治疗急性胆囊炎患者疗效研究^*

Percutaneous transhepatic gallbladder drainage and sequential laparoscopic cholecystectomy with preservation of main cystic artery in the treatment of patients with acute cholecystitis

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