不同时间行胆囊结石并急性胆囊炎腹腔镜胆囊切除术对比研究  

A comparison study of laparoscopic cholecystectomy for acute cholecystitis at different time

作　　者：廖传文[1] 胡淑琴[1] 曹虹[1] 

机构地区：[1]江西省人民医院普外科,南昌330006

出　　处：《江西医药》2013年第3期189-191,共3页Jiangxi Medical Journal

摘　　要：目的探讨不同时间行急性胆囊炎腹腔镜胆囊切除术的临床疗效。方法回顾分析我院2007年10月至2012年10月117例急性胆囊炎患者行腹腔镜胆囊切除术的临床资料。按照发病距手术时间将患者分为3组:A组(24h内)、B组(24-72h)、C组(72h-1周),各组患者均行腹腔镜胆囊切除术,对患者术前一般情况、术中病理改变、手术时间、术中出血量、中转开腹率及术后并发症和住院费用进行对比。结果本组117例中转开腹率为14.5%,其中A组中转率为0,B组中转率为13%,C组中转率为34.3%,组内比较及组间两两比较P<0.05。C组胆囊被大网膜包裹及胆囊三角呈纤维化改变及行胆囊大部分切除比率均明显高于A组及B组(P<0.05)。B组和C组均有胆囊坏疽,两组间无明显差异性(P>0.05),而A内组胆囊坏疽为0。手术时间及术中出血量组内比较及组间两两比较均有显著性差异(P<0.05),但胆管损伤和术后胆漏等严重并发症无明显区别(P>0.05)。术后住院排气时间及术后住院天数,C组明显长于A组和B组(P<0.05),而A内组和B组中间无显著性差异(P<0.05)。A组住院总费用最低,各组间比P<0.05。结论胆囊结石并急性胆囊炎腹腔镜切除术是安全的,但距起病时间大于72h时手术风险和难度均增大,中转开腹比率增加,以起病24h内手术时机最佳。Objective To evaluate the clinical effect of laparoscopic cholecystectomy at different time.Methods 117 patients of acute cholecystitis were divided into three groups by the time from the onset to surgery,group A(within 24 hours),group B(24-72hours),and group C(72hours-1 week).All patients were undergone laparoscopic cholecystectomy.General condition before the operation,pathologic type of cholecystitis,operation time,intraoperative blood loss,conversion rate to open surgery,complications,hospital stays,and costs were compared within the three groups.Results Conversion rate to open surgery was 0.13%,34.5% in group A,group B and group C respectively,which has significant difference between different groups.Gallbladder packaged by omentum,gallbladder triangle fibrosis were obvious in group C,and subtotal cholecystectomy was underwent only in group C.Gallbladder wall were found necrosis in group C and group B,but was not found in group A.There were significant difference in the operation time,intraoperative blood loss in three groups,but there was no significant difference regarding biliary tract injury or biliary leak.Postoperative hospital stays and postoperative exhaust time in group C were much longer than group B or group A,but there was no significant difference in group B and group C,and costs of group A was the lowest of all.Conclusion Laparoscopic cholecystectomy is a safe and feasible procedure for patients with acute cholecystitis.When the duration of symptoms is longer than three days,operation difficulty and risk is increased,and a higher conversion rate will be seen,then performing operation within 24 hours is the best choice.

关 键 词：胆囊结石并急性胆囊炎 胆囊切除术 腹腔镜 手术时机 

分 类 号：R9[医药卫生—药学]