摘要
目的探讨经皮肝穿刺胆道引流(PTCD)术联合腹腔镜胆囊切除术在老年急性胆囊炎患者中的应用效果及对胆囊组织中巨噬细胞的影响。方法将76例老年急性胆囊炎患者随机分为对照组与观察组,每组38例。两组患者均采用腹腔镜胆囊切除术治疗,但观察组在行腹腔镜胆囊切除术前先行PTCD术治疗。比较两组患者围术期指标、肝功能指标、并发症发生率、中转开腹手术率及胆囊组织中巨噬细胞水平。结果两组患者腹腔镜胆囊切除术手术时间差异无统计学意义(P>0.05),但观察组术中出血量、中转开腹手术率、术后开始进食时间、术后住院时间、术后首次肛门排气时间均少于、低于或短于对照组(均P<0.05)。两组患者腹腔镜胆囊切除术术后7 d的AST、ALT及TBIL水平均低于术前,且观察组上述指标水平均低于对照组(均P<0.05),两组患者的术后并发症发生率、胆囊组织中巨噬细胞计数比较,差异均无统计学意义(均P>0.05)。结论PTCD联合腹腔镜胆囊切除术治疗老年急性胆囊炎患者创伤较小,可以改善肝功能,降低术后并发症发生率及中转开腹手术率,且未对胆囊组织中的巨噬细胞产生影响,利于患者术后恢复。
Objective To investigate the application effect of percutaneous transhepatic cholangial drainage(PTCD)combined with laparoscopic cholecystectomy on elderly patients with acute cholecystitis and its impact on macrophages in gallbladder tissue.Methods Seventy-six elderly patients with acute cholecystitis were randomly divided into control group and observation group,with 38 cases in each group.Patients of both groups underwent laparoscopic cholecystectomy,whereas the observation group was treated with PTCD prior to laparoscopic cholecystectomy.Perioperative indexes,liver function indexes,incidence rate of complications,rate of conversion to laparotomy,and the level of macrophages in gallbladder tissue were compared between the two groups.Results No statistically significant difference was found in duration of laparoscopic cholecystectomy between the two groups(P>0.05),whereas the observation group yielded less intraoperative blood loss,lower rate of conversion to laparotomy,shorter duration to start eating postoperatively,shorter postoperative hospital stay,and decreased time to first anal exhaust after operation as compared with the control group(all P<0.05).Seven days after laparoscopic cholecystectomy,the levels of AST,ALT and TBIL in the two groups were lower than those before operation,and the levels of the aforementioned indexes in the observation group were lower than those in the control group(all P<005),there was no statistically significant difference between the two groups in incidence rate of postoperative complications,or macrophage count in gallbladder tissue(all P>0.05).Conclusion PTCD combined with laparoscopic cholecystectomy results in minor trauma in the treatment of elderly patients with acute cholecystitis,which can improve liver function,reduce the incidence rate of postoperative complications as well as the rate of conversion to laparotomy,and has no impacts on macrophages in gallbladder tissue.It is beneficial to patients′postoperative recovery.
作者
张宇飞
何亮
徐国栋
张建国
闫杰
ZHANG Yu-fei;HE Liang;XU Guo-dong;ZHANG Jian-guo;YAN Jie(Department of General Surgery,Pinggu Hospital,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 101200,China;Department of Hepatology,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China)
出处
《广西医学》
CAS
2021年第15期1801-1804,共4页
Guangxi Medical Journal
基金
北京市医院管理局消化内科学科协同发展中心消化专项(XXT27)。
关键词
急性胆囊炎
经皮肝穿刺胆道引流
腹腔镜胆囊切除术
临床效果
胆囊组织
巨噬细胞
老年人
Acute cholecystitis
Percutaneous transhepatic cholangial drainage
Laparoscopic cholecystectomy
Clinical effect
Gallbladder tissue
Macrophage
Elderly people
