经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗高龄急性重症胆囊炎的临床观察.docVIP

经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗高龄急性重症胆囊炎的临床观察 　　摘要：目的 探讨经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗高龄急性重症胆囊炎的临床效果。方法 将78例高龄急性重症胆囊炎患者随机分组，治疗组（n=39）实行经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗，对照组（n=39）行急诊腹腔镜胆囊切除术治疗，对比两组疗效。结果 治疗组患者并发症发生率是5.13%，中转开腹率是2.56%，平均住院时间是（10.06±1.24） d；对照组患者并发症发生率是20.51%，中转开腹率是23.08%，平均住院时间是（21.41±2.05） d；两组患者并发症发生率、中转开腹率和平均住院时间的组间对比均有统计学差异（P0.05或P0.01）。结论 经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗高龄急性重症胆囊炎的临床效果肯定，可推广。 　　关键词：经皮经肝胆囊穿刺；腔镜胆囊切除；高龄急性重症胆囊炎 　　Abstract：Objective To evaluate percutaneous transhepatic gallbladder sequential endoscopic cholecystectomy in treatment of elderly patients with severe acute cholecystitis clinical results. Methods 78 patients with severe acute cholecystitis in elderly patients randomized to the treatment group （n = 39） the implementation of percutaneous transhepatic gallbladder laparoscopic cholecystectomy sequential treatment，the control group（n = 39） underwent emergency laparoscopic cholecystectomy Comparative efficacy of group 2. Results The rate of complications was 5.13% in treatment group， 2.56% in conversion rate and （10.06 ± 1.24） d；in control group.The complication rate was 20.51% in the control group，23.08% in the control group， The hospital stay was（21.41 ± 2.05） d.There were significant differences in the incidence of complications，conversion rate and average hospital stay between the two groups（P 0.05 or P 0.01）. Conclusion Percutaneous transhepatic gallbladder sequential endoscopic cholecystectomy in treatment of elderly patients with severe acute cholecystitis clinical effects are， can be extended. 　　Key words：Percutaneous transhepatic gallbladder；Laparoscopic cholecystectomy；Elderly patients with severe acute cholecystitis 　　高龄急性重症胆囊炎作为普外科最常见的急腹症之一，多因胆囊结石引发胆囊管梗阻所导致，以腹内阵发性绞痛、腹肌强直等为主要临床症状[1]。目前，手术为高龄急性重症胆囊炎首选治疗措施，但因高龄患者普遍存在糖尿病、高血压等内科疾病，因此需选取安全可靠的手术方式。本研究为明确经皮经肝胆囊穿刺序贯腔镜胆囊切除治疗高龄急性重症胆囊炎的临床效果，将78例高龄急性重症胆囊炎患者随机分组，分别予以经皮经肝胆囊穿刺序贯腔镜胆囊切除术、急诊腹腔镜胆囊切除术，现报道两组并发症发生率、中转开腹率和住院时间如下。 　　1 资料与方法 　　1.1一般资料 纳入本次研究的78例高龄急性重症胆囊炎患者均为医院自2015年4月～2016年3月收治，已经CT和超声等检查明确诊断为高龄急性重症胆囊炎，排除合并合并器官衰竭性病症、过敏体质者、依