空军军医大学学报2025，Vol.46Issue(9)：1170-1175,1180,7.DOI:10.13276/j.issn.2097-1656.2025.09.009
经皮经肝胆囊穿刺引流术序贯腹腔镜胆囊切除术对急性重症胆囊炎患者术后疼痛及炎症应激反应的影响
Effect of percutaneous transhepatic gallbladder drainage sequential laparoscopic cholecystectomy on postoperative pain and inflammatory stress response in patients with acute severe cholecystitis
摘要
Abstract
Objective To investigate the effects of percutaneous transhepatic gallbladder drainage(PTGD)followed by laparoscopic cholecystectomy(LC)on postoperative pain and inflammatory stress responses in patients with acute severe cholecystitis(ASC).Methods ASC patients were selected from April 2023 to March 2025,all of which came from Shangyu Branch of the Second Affiliated Hospital,Zhejiang University School of Medicine,and were divided into control group and study group by different treatment schemes and 1∶1 ratio,with 58 cases in each group.The control group underwent LC within 24 h of admission,while the study group underwent PTGD within 24 h of admission,followed by LC 3-5 d after operation.Both groups were followed up for 3 months after LC.The perioperative indicators,hospital stay,hospitalization costs,pain levels at 1,2,and 3 d after operation,and liver function,inflammation,and stress indicators before surgery and 3 d after operation,as well as complications during follow-up between the two groups were compared.Results Compared with the control group,the study group had less intraoperative blood loss,shorter operation,postoperative tube retention,postoperative anal exhaust and hospital stay,and higher hospitalization costs(P＜0.001).Compared with 1 d after operation,Visual Analogue Scale(VAS)scores of the two groups at 2 and 3 d after operation decreased gradually(P＜0.001),and VAS scores of the study group at 1,2 and 3 d after operation were lower than those of the control group(P＜0.01).Compared with before operation,the levels of serum γ-glutamyl transferase,alanine aminotransferase,aspartate aminotransferase,total bilirubin,C-reactive protein,interleukin-17 and high mobility group box-1 in the two groups decreased at 3 d after operation,and those in the study group were lower than those in the control group(P＜0.001).The levels of serum glutathione peroxidase in the two groups decreased,and those in the study group were higher than those in the control group(P＜0.001).The levels of serum adrenocorticotropic hormone and cortisol in the two groups increased,and those in the study group were lower than those in the control group(P＜0.001).The overall complication rate during follow-up was lower in the study group(10.34％)than in the control group(24.14％)(P＜0.05).Conclusion PTGD sequential LC can improve perioperative indicators in ASC patients,shorten hospital stays,improve liver function,reduce postoperative pain and inflammatory stress responses,and has a high safety.However,this approach involves higher hospitalization costs,and clinicians should select the appropriate surgical option based on the patient's specific condition.关键词
急性重症胆囊炎/经皮经肝胆囊穿刺引流术/腹腔镜胆囊切除术/疼痛/肝功能/炎症/应激反应/并发症Key words
acute severe cholecystitis/percutaneous transhepatic gallbladder drainage/laparoscopic cholecystectomy/pain/liver function/inflammation/stress response/complications分类
医药卫生引用本文复制引用
邵金海,王东智,杜欢龙,邱晨,杨玉龙,蔡小泥..经皮经肝胆囊穿刺引流术序贯腹腔镜胆囊切除术对急性重症胆囊炎患者术后疼痛及炎症应激反应的影响[J].空军军医大学学报,2025,46(9):1170-1175,1180,7.基金项目
浙江省中医药科技计划项目(2025ZX292) （2025ZX292）
