腹腔镜胆囊切除术手术时机对急性重症胆囊炎患者的影响研究

Influence of laparoscopic cholecystectomy operation timing on patients with acute severe cholecystitis

摘要:

目的 探究经皮经肝胆囊引流术(PTGD)术后腹腔镜胆囊切除术(LC)手术时机对急性重症胆囊炎(ASC)患者中转开腹率及血清炎症因子的影响。方法 选取2020年11月至2024年11月湖北省荆州市中心医院经PTGD术后行LC的102例ASC患者，按照LC的手术介入时机，分成早期组(n=53,PTGD后3～4周实施LC治疗)与晚期组(n=49,PTGD后7～8周实施LC治疗),比较两组患者手术相关指标、住院时间、胆囊壁厚度、胆囊水肿程度、血清炎症因子[降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平、并发症发生率等。结果 两组患者中转开腹率差异无统计学意义(P>0.05);与晚期组比较，早期组LC手术时间、术中出血量、住院时间均更低(P<0.05);与早期组比较，晚期组胆囊壁厚度更薄，胆囊水肿程度更轻(P<0.05);术后1 d,两组患者PCT、IL-6、CRP水平均较术前升高，但与早期组比较，晚期组更低(P<0.05);术后3 d,两组患者PCT、IL-6、CRP水平均较术前降低，但与早期组比较，晚期组更低(P<0.05);两组患者并发症发生率比较，差异无统计学意义(P>0.05)。结论 PTGD后3～4周LC可缩短手术时间、减少术中出血量和住院时间，而PTGD后7～8周LC虽恢复较慢，但炎症因子下降更明显，胆囊壁更薄，水肿程度更轻；两种手术时机中转开腹率及并发症发生率相近。

Abstract:

Objective Toinvestigatetheeffectofsurgicaltiming oflaparoscopiccholecystectomy (LC)after percutaneoustranshepaticgallbladderdrainage (PTGD)ontherateofconversiontolaparotomyandseruminflammatory markersinpatientswithacuteseverecholecystitis(ASC).Methods Atotalof102patientswithASCwhoreceivedLCafter PTGDatJingzhouCentralHospital,HubeiProvincefromNovember2020toNovember2024wereselected.Accordingtothe interventiontimingofLC,thepatientsweredividedintoanearlygroup(n=53,LCat3-4weeksafterPTGD)andalate group(n=49,LCat7-8 weeksafterPTGD).Thedifferencesinsurgery-relatedindicators,lengthofstay (LOS), gallbladderwallthickness,gallbladderedema degree,levelsofserum inflammatory markers (procalcitonin (PCT), interleukin-6 (IL-6),C-reactiveprotein (CRP))andincidenceofcomplicationswerecomparedbetweenthetwogroups. Results Therewasnosignificantdifferenceintherateofconversiontolaparotomybetweenthetwogroups(P>0.05). Comparedwiththelategroup,theearlygroupdemonstratedshortersurgicalduration,lessintraoperativebloodloss,and shorterLOS(P<0.05).Compared withtheearlygroup,thelategroupexhibitedthinnergallbladderwalland milder gallbladderedemaseverity(P<0.05).Onpostoperativeday (POD)1,thelevelsofPCT,IL-6andCRPinbothgroups wereelevatedcomparedtopreoperativelevels,andthelevelswerelowerinthelategroupthanthoseintheearlygroup (P<0.05).OnPOD3,theselevelsdecreasedinbothgroupscomparedtopreoperativelevels,andthelevelsremainedlower inthelategroup(P<0.05).Therewasnosignificantdifferenceintheincidenceofcomplicationsbetweenthetwogroups (P>0.05).Conclusion LCat3-4weeksafterPTGDshortensthesurgicalduration,reducestheintraoperativebloodloss andLOS.LC at7-8 weeksafterPTGD resultsinslowerrecovery butdemonstrates morepronouncedreductionsin inflammatory markers,thinner gallbladder walls,and milder edema severity.Both surgicaltiming strategies show comparablerateofconversiontolaparotomyandincidenceofcomplications