损伤控制理念在老年中重度急性胆囊炎治疗中的应用

目的探讨损伤控制理念在老年中重度急性胆囊炎治疗中的应用。方法回顾性收集2014年1月至2016年1月上海市浦东医院收治的148例老年中重度急性胆囊炎患者的临床资料;比较患者行经皮经肝胆囊穿刺引流术(PTGBD)后择期行LC(择期LC组,n=52例)和急诊行LC(急诊LC组,n=96例)的有效性及安全性。结果 PTGBD后择期LC组患者术中出血量较少(P0.05);两组中转开腹率差异虽无统计学意义(P0.05),但PTGBD后择期LC组中转开腹率较低(5.77%vs 12.50%);PTGBD后择期LC组并发症总发生率为40.38%,显著低于急诊LC组的59.38%(P0.05)。结论结合损伤控制理念,对老年中重度急性胆囊炎患者PTGBD后行择期LC手术能有效降低手术风险,是治疗老年中重度急性胆囊炎的优选方案。

Application of damage control theory on senile patients with moderate and severe acute chole-cystitis

Objective To evaluate the clinical application of damage control theory on senile patients with moderate and severe acute cholecystitis. Methods The clinical data of 148 senile patients with moderate and se-vere acute cholecystitis collected from Jan. 2014 to Jan. 2016 in Shanghai Pudong Hospital were retrospectively analyzed. Patients were divided into selective LC after perecutaneous transhepatic gallbladder drainage (PTGBD) group (n=52) and emergency LC group (n=96). The difference of efficacy and safety were compared between two groups. Results Less bleeding was found in selective LC group (P<0.05). Though there was no statistically significant difference between the two groups, the conversion rate to laparotomy was lower in selective LC group (5.77% vs 12.50%). The morbidity in selective LC group and emergency LC group were 40.38% and 59.38% re-spectively, which had significant difference (P<0.05). Conclusion According to damage control theory, selective LC after PTGBD has more advantages than emergency LC for the treatment of senile moderate and severe acute cholecystitis.