Ni Qingqiang, Chen Dongbo, Xu Rui, Shang Dong
From the Medical college of Soochow University, Suzhou, Jiangsu (QN); Department of General Surgery, Pancreato-Biliary Center, First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning (QN, DC, DS); Department of General Surgery, Fujian Provincial Longyan First Hospital (DC) and Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, P.R. China (RX).
Medicine (Baltimore). 2015 Aug;94(34):e1442. doi: 10.1097/MD.0000000000001442.
To evaluate the efficacy of percutaneous transhepatic gallbladder drainage (PTGD) for high-risk elderly patients with acute cholecystitis.Retrospective analysis of 159 acute cholecystitis patients who were admitted to General Surgery Division III of the First Affiliated Hospital of Dalian Medical University between January 2005 and November 2012. A total of 123 patients underwent laparoscopic cholecystectomy (LC), and 36 received only PTGD treatment. The LC patients were divided into 3 groups based on their preoperative treatment: group A, emergency patients (33 patients); group B (26 patients), patients who were treated with PTGD prior to LC; and group C (64 patients), patients who received nonsurgical treatment prior to LC. General conditions, LC surgery duration, intraoperative blood loss, rate of conversion to open surgery, incidence of postoperative complications, total fasting time, and total hospitalization time were analyzed and compared among the 3 groups.The remission rates of patients in the PTGD treatment groups (including group B and PTGD treatment only group) were significantly higher within 24 and 48 hours than those of patients who received nonsurgical treatment prior to LC (P < 0.05). Among the patients in the 3 surgery groups, the operation conversion rate (19.2%) of group B was significantly higher than that of group A (3.0%) and group C (1.6%) (P < 0.05). The total hospitalization time of the patients in group B (18.5 ± 4.5 days) was longer than that of the patients in group A (8.2 ± 3.9 days) and group C (10.5 ± 6.4 days). The total fasting time of the patients in group A (2.4 ± 1.2 days) was significantly shorter than that of those in group B (4.1 ± 1.7 days) and group C (3.4 ± 2.7 days) (P < 0.05).For high-risk elderly patients, if there is any emergency surgery contraindication, PTGD therapy may be safe and effective and can relieve the symptoms within a short time. For acute cholecystitis patients without surgery contraindications, emergency surgery should be performed as soon as possible after diagnosis.
评估经皮经肝胆管引流术（PTGD）对高危老年急性胆囊炎患者的疗效。回顾性分析2005年1月至2012年11月大连医科大学附属第一医院普通外科三病房收治的159例急性胆囊炎患者。其中123例行腹腔镜胆囊切除术（LC），36例仅接受PTGD治疗。将LC患者根据术前治疗情况分为3组：A组，急诊患者（33例）；B组（26例），LC术前接受PTGD治疗的患者；C组（64例），LC术前接受非手术治疗的患者。分析比较3组患者的一般情况、LC手术时长、术中出血量、中转开腹手术率、术后并发症发生率、总禁食时间和总住院时间。PTGD治疗组（包括B组和单纯PTGD治疗组）患者在24小时和48小时内的缓解率显著高于LC术前接受非手术治疗的患者（P<0.05）。3个手术组患者中，B组的手术中转率（19.2%）显著高于A组（3.0%）和C组（1.6%）（P<0.05）。B组患者的总住院时间（18.5±4.5天）长于A组（8.2±3.9天）和C组（10.5±6.4天）。A组患者的总禁食时间（2.4±1.2天）显著短于B组（4.1±1.7天）和C组（3.4±2.7天）（P<0.05）。对于高危老年患者，若存在急诊手术禁忌证，PTGD治疗可能安全有效且能在短时间内缓解症状。对于无手术禁忌证的急性胆囊炎患者，确诊后应尽快行急诊手术。
