目的：探讨超声引导下经皮经肝胆囊穿刺造瘘术联合腹腔镜胆囊切除术治疗老年急性胆囊炎的疗效。方法：选取濮阳市人民医院2022年6月至2023年12月收治的60例老年急性重症结石性胆囊炎患者,随机分为超声引导下经皮经肝胆囊穿刺造瘘术联合腹腔镜胆囊切除术组(观察组)和腹腔镜胆囊切除术组(对照组),每组30例。观察比较两组患者VAS评分、术中出血量和手术时间、术后首次下床时间、住院时间、术后并发症发生情况以及围术期内分泌激素(皮质醇和肾上腺素)水平。结果：观察组VAS评分低于对照组患者(P＜0.05);观察组术中出血少于对照组,术后首次下床时间、住院时间短于对照组、术后并发症发生低于对照组(P＜0.05);观察组皮质醇和肾上腺素水平低于对照组(P＜0.05)。结论：腹腔镜胆囊切除术患者优先进行超声引导下经皮经肝胆囊穿刺造瘘术,能降低术后疼痛感及手术应激反应,同时有效减少并发症发生,改善患者术后康复质量。
Objective:To study the efficacy of ultrasound-guided percutaneous transhepatic gallbladder fistula combined with laparoscopic cholecystectomy in the treatment of acute cholecystitis in the elderly. Methods: A total of 60 elderly patients with acute severe calculous cholecystitis admitted to Puyang People's Hospital from June 2022 to December 2023 were randomly divided into ultrasound-guided percutaneous transhepatic gallbladder fistula combined with laparoscopic cholecystectomy group (observation group) and laparoscopic cholecystectomy group (control group), with 30 patients in each group. The VAS score, intraoperative blood loss and operation time, the first time to get out of bed after operation, hospitalization time, postoperative complications and perioperative endocrine hormones, cortisol and adrenaline levels were observed and compared between the two groups. Results: The VAS score of the observation group was lower than that of the control group (P＜0.05). The intraoperative bleeding in the observation group was less than that in the control group, the first time of getting out of bed after operation and hospitalization time in the observation group were shorter than those in the control group, the incidence of postoperative complications in the observation group was less than that in the control group (P＜0.05). The levels of cortisol and epinephrine in the observation group were lower (P＜0.05). Conclusion: Ultrasound-guided percutaneous transhepatic gallbladder puncture and fistulation in patients with laparoscopic cholecystectomy can better reduce postoperative pain and surgical stress response, and effectively reduce the occurrence of complications and improve the quality of postoperative rehabilitation.
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