探讨经皮经肝胆囊穿刺引流（PTGBD）联合腹腔镜胆囊切除术（LC）在急性胆囊炎合并糖尿病治疗中的应用价值。

回顾性分析2013年1月至2015年12月在中山大学附属江门市中心医院接受LC治疗的34例急性胆囊炎合并糖尿病患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据手术方式将患者分为LC组和PTGBD+LC组。其中LC组20例，男9例，女11例；平均年龄（59±9）岁；入院后给予对症支持治疗，待感染控制后出院，3个月內择期行LC。PTGBD+LC组14例，男6例，女8例；平均年龄（62±9）岁；入院后行PTGBD，同时给予对症支持治疗，待感染控制后出院，3个月內择期行LC。观察两组患者的术中和术后情况。两组正态分布资料比较采用t检验，偏态分布资料比较采用Z检验。

所有患者均手术成功。LC组患者的手术时间中位数为70（35～210）min，明显长于PTGBD+LC组的53（30～195）min（Z=2.038，P<0.05）。LC组的术中出血量为18（10～50）ml，明显多于PTGBD+LC组的13（5～50）ml（Z=2.049，P<0.05）。LC组中转开腹率25%（5/20），PTGBD+LC组无中转开腹病例。LC组术后住院时间为（4.9±1.8）d，明显长于PTGBD+LC组的（4.1±1.0）d（t=0.432，P<0.05）。两组均无围手术期死亡。两组LC术后均未发生并发症。PTGBD术后发生并发症4例，其中胆漏3例，腹腔出血1例，经保守治疗后治愈。

PTGBD联合LC治疗急性胆囊炎合并糖尿病安全、有效，能明显缩短手术时间，减少术中出血量，并加快患者术后康复。

To investigate the application value of percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis complicated with diabetes mellitus.

Clinical data of 34 patients with acute cholecystitis complicated with diabetes mellitus who underwent LC in Jiangmen Central Hospital affiliated to Sun Yat-sen University from January 2013 to December 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the surgical methods, the patients were divided into the LC group (n=20) and PTGBD+LC group (n=14). In the LC group, 9 were males and 11 were females, aged (59±9) years old on average. The patients received symptomatic and supportive treatment after admission, and discharged from hospital after the infection was controlled and underwent selective LC within 3 months. In the PTGBD+LC group, 6 were males and 8 were females, aged (62±9) years old on average. The patients underwent PTGBD after admission and received symptomatic and supportive treatment at the same time. The patients discharged from hospital after the infection was controlled and underwent selective LC within 3 months. Intraoperative and postoperative conditions of two groups were observed. Normally-distributed data were compared between two groups using t test. Skewed distributed data were compared using Z test.

All patients underwent the surgery successfully. The median operation time in the LC group was 70(30-210) min, significantly longer than 53(30-195) min in the PTGBD+LC group (Z=2.038, P<0.05). The median intraoperative blood loss in the LC group was 18(10-50) ml, significantly more than 13(5-50) ml in the PTGBD+LC group (Z=2.049, P<0.05). The percentage of conversion to laparotomy in the LC group was 25%(5/20), while no conversion to laparotomy was observed in the PTGBD+LC group. The postoperative length of hospital stay in the LC group was (4.9±1.8) d, significantly longer than (4.1±1.0) d in the PTGBD+LC group (t=0.432, P<0.05). No perioperative death and complication after LC was observed in both group. Four cases of complications after PTGBD were observed, including 3 cases of bile leakage and 1 of intraperitoneal bleeding, which were cured after conservative therapy.

PTGBD combined with LC is a safe and effective treatment for acute cholecystitis complicated with diabetes mellitus. It can obviously shorten the operation time, reduce the intraoperative blood loss and accelerate the postoperative recovery of the patients.