急性结石性胆囊炎行LC术难易程度的相关因素分析  

Factors related with difficulty of LC in acute calculus cholecystitis

作　　者：李军[1] 张辉[1] 朱雷鸣 丁峻岭[1] 

机构地区：[1]上海市长宁区中心医院肝胆外科,上海200336

出　　处：《中国普通外科杂志》2009年第8期782-785,共4页China Journal of General Surgery

摘　　要：目的探讨急性结石性胆囊炎行LC(Laparoscopic Cholecystectomy,LC)手术难易程度的相关因素。方法将245例急性结石性胆囊炎患者根据手术时间和有无中转分成容易组(123例)和困难组(122例)(含中转开腹组33例open cholecystectomy,OC),分别比较各组术前一般资料、术前影像学差异和腹腔镜下所见,筛选出有统计学差异的指标。结果术前资料中,容易组和困难组在体温、白细胞计数,手术时机、胆囊壁厚度、胆囊体积、胆总管直径各指标间差异有统计学意义(均P<0.05);术中镜下所见,两组在胆囊壁厚度、大小、颈部结石嵌顿、胆总管直径、胆囊三角各指标间差异均有统计学意义(均P<0.01)。结论急性结石性胆囊炎体温升高,白细胞计数增加,胆囊壁增厚、胆囊体积增大、胆总管直径大于8mm、颈部结石嵌顿、Calot三角不清是行LC困难的因素。Objective To explore the factors related with difficulty of laparoscopic cholecystectomy （ LC ） for acute calculus cholecystitis. Methods A total of 245 patients were retrospectively divided into two groups ： easy group （ 123 patients ） and difficult group （ 122 patients, including 32 patients of conversion to OC ） based on surgery time and LC or OC. Results There were statistical differences between the groups in regards to preoperative body temperature, white blood cell count, surgical timing, the thickness of gallbladder wall, gallbladder volume, and diameter of common bile duct （ all P 〈 0.05 ） ; and there were obvious statistical differences between the 2 groups in thickness of gallbladder wall, gallbladder volume, diameter of common bile duct, stone impaction in the neck of gallbladder, and the condition of Calot＇s triangle during operation （ all P 〈 0. 01 ）. Conclusions Factors related to difficulty of LC in acute calculus cholecystitis include elevated body temperature, increased white blood cell count, thickened gallbladder wall, increased gallbladder volume, common bile duct diameter more than 8 mm, stone impaction in neck of gallbladder and unclear anatomy of Calot＇ s triangle.

关 键 词：胆囊结石 胆囊炎 急性 胆囊切除术 腹腔镜 难易程度判定 因素分析 

分 类 号：R657.4[医药卫生—外科学]