Yang Jia-Peng, Tian Zhong
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
Evid Based Complement Alternat Med. 2022 Jul 20;2022:2071326. doi: 10.1155/2022/2071326. eCollection 2022.
To assess the effect of laparoscopic cholecystectomy for acute cholecystitis after percutaneous transhepatic gallbladder drainage (PTGBD).
A total of 70 patients with acute cholecystitis diagnosed and treated in our hospital between April 2020 and November 2021 were recruited and assigned to receive either conventional treatment (conventional group) or PTGBD plus laparoscopic cholecystectomy (experimental group) according to the order of admission (with January 2021 as the cut-off time point), with 35 cases in each group. Outcome measures included treatment outcomes, surgical indices, and postoperative recovery.
Patients in the experimental group showed significantly less intraoperative hemorrhage volume and shorter operative time, time-lapse before passing gas, and hospital stay (83.15 ± 31.17, 32.54 ± 12.61, 23.02 ± 4.61, 7.98 ± 3.24) versus those in the conventional group (120.56 ± 30.55, 61.01 ± 15.54, 28.15 ± 5.91, 11.95 ± 4.15) ( < 0.05). The incidence of conversion to open surgery and postoperative drainage in the experimental group was significantly lower (2.86%, 5.71%) than that of the conventional group (25.71%, 45.71%) ( < 0.05). The differences in the postoperative body temperature of the two groups did not come up to statistical standard ( > 0.05). The experimental group had faster body temperature recovery and leukocyte recovery and better leukocyte levels (1.25 ± 0.56, 2.36 ± 0.48, 7.92 ± 1.36) than the conventional group (3.11 ± 1.05, 5.41 ± 0.63, 10.52 ± 2.78) ( < 0.05). There was 1 (2.86%) case of pneumothorax and 1 (2.86%) case of intestinal bleeding in the experimental group, and there were 2 (5.71%) cases of biliary leakage, 3 (8.57%) cases of pneumothorax, 4 (11.43%) cases of intestinal bleeding, 5.71% cases of incisional infection, 1 (2.86%) case of respiratory failure, and 1 (2.86%) case of liver damage in the conventional group. The experimental group showed a significantly lower incidence of complications (5.71%) versus the conventional group (37.14%) ( < 0.05).
PTGBD plus laparoscopic cholecystectomy for acute cholecystitis effectively improves surgical safety, promotes patients' postoperative recovery, and reduces the incidence of conversion to open surgery and postoperative complications with a high safety profile. Further trials are, however, required prior to clinical promotion.
评估经皮经肝胆道引流术（PTGBD）后行腹腔镜胆囊切除术治疗急性胆囊炎的效果。
选取2020年4月至2021年11月在我院诊断并治疗的70例急性胆囊炎患者，根据入院顺序（以2021年1月为分界时间点）分为接受传统治疗的常规组和接受PTGBD联合腹腔镜胆囊切除术的试验组，每组35例。观察指标包括治疗效果、手术指标及术后恢复情况。
试验组患者术中出血量显著少于常规组，手术时间、排气时间及住院时间均短于常规组（试验组：83.15±31.17、32.54±12.61、23.02±4.61、7.98±3.24；常规组：120.56±30.55、61.01±15.54、28.15±5.91、11.95±4.15）（P<0.05）。试验组中转开腹手术及术后引流的发生率显著低于常规组（分别为2.86%、5.71%和25.71%、45.71%）（P<0.05）。两组术后体温差异无统计学意义（P>0.05）。试验组体温恢复及白细胞恢复更快，白细胞水平优于常规组（试验组：1.25±0.56、2.36±0.48、7.92±1.36；常规组：3.11±1.05、5.41±0.63、10.52±2.78）（P<0.05）。试验组发生1例（2.86%）气胸和1例（2.86%）肠道出血，常规组发生2例（5.71%）胆漏、3例（8.57%）气胸、4例（11.43%）肠道出血、5.71%切口感染、1例（2.86%）呼吸衰竭和1例（2.86%）肝损伤。试验组并发症发生率显著低于常规组（5.71%比37.14%）（P<0.05）。
PTGBD联合腹腔镜胆囊切除术治疗急性胆囊炎可有效提高手术安全性，促进患者术后恢复，降低中转开腹手术及术后并发症的发生率，安全性高。然而，在临床推广之前还需要进一步试验。
