不同手术方案在急性结石性胆囊炎患者中的应用效果对比

目的探讨不同手术方案在急性结石性胆囊炎患者中的应用效果。 方法回顾性分析2013年1月至2016年6月收治的221例急性结石性胆囊炎患者资料，根据治疗方案分为腹腔镜下胆囊切除术(LC)组(行急诊LC术，n＝152)、经皮肝胆囊穿刺引流术(PTGD)＋LC组(n＝46)、开腹胆囊切除术(OC)组(n＝23)。采用SPSS19.0统计学软件进行分析，术中术后指标以均数±标准差表示，两组比较用t检验，多组比较采用方差分析；术后并发症发生率采用χ²检验；P<0.05差异有统计学意义。 结果⑴PTGD＋LC组的年龄、胆囊炎严重程度明显高于另外两组(P<0.05)；三组的其他基线资料比较，差异均无统计学意义(P>0.05)。⑵PTGD＋LC组的手术时间显著高于LC组，总住院时间、总住院费用均显著高于另外两组(P<0.05)。OC组的术中出血量显著高于另外两组(P<0.05)。LC组和PTGD＋LC组中转开腹率比较，差异无统计学意义(P>0.05)。三组的术后并发症发生率比较，差异无统计学意义(P>0.05)。 结论对于无明显手术禁忌症的急性结石性胆囊炎患者而言，急诊LC是首选治疗方法，对于暂时不直接实施手术者可先行PTGD术，之后再考虑下一步治疗。

Comparison of different surgical procedures in treating patients with acute calculous cholecystitis

ObjectiveTo investigate the effect of different surgical procedures in treating patients with acute calculous cholecystitis. MethodsA retrospective analysis were performed in 221 patients with acute calculous cholecystitis from January 2013 to June 2016 in our hospital, who were divided into laparoscopic cholecystectomy (LC) group (emergency LC, n=152), percutaneous transhepatic gallbladder drainage (PTGD) + LC group (n=46) and open cholecystectomy (OC) group (n=23). Baseline and clinical data were compared between three groups. Statistical analysis were performed by using SPSS19.0 statistical software. Measurement data such as perioperative indicators were expressed as mean±standard deviation and examined by using t-test and analysis of variance. The incidence of postoperative complications and baseline data were compared by using chi square test. A P value of <0.05 was considered as statistically significant difference. Results⑴Age and severity of cholecystitis in PTGD+ LC group were significantly higher than those in other two groups respectively (P<0.05). There were no significant difference between three groups in terms of gender, preoperative clinical symptoms and liver function indexes (P>0.05). ⑵Operation time in PTGD+ LC group was significantly higher than that in LC group, and total hospitalization time and hospitalization expenses in PTGD+ LC group were significantly higher than those in other two groups respectively (P<0.05). The intraoperative blood loss in OC group was significantly higher than that in other two groups (P<0.05). There was no significant difference of conversion rate between LC group and PTGD+ LC group (P >0.05). There was no significant difference of the incidence of postoperative complications between three groups (P>0.05). ConclusionsFor patients with acute calculous cholecystitis without obvious surgical contraindications, emergency LC is the preferred treatment method. For those who could not undergo emergency surgery, PTGD cuold be performed first, then considering the next step.