急性胆囊炎腹腔镜胆囊切除术最佳手时机的选择  

Optimal operative timing of laparoscopic cholecystectomy for acute cholecystitis

作　　者：李忠山[1] 孔胜兵[1] 杨国平[1] 詹志林[1] 李海宏[1] 

机构地区：[1]池州市人民医院肝胆外科,池州247000

出　　处：《肝胆外科杂志》2013年第6期426-428,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨急性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术时机。方法回顾性分析我院2005年1月~2013年1月间,402例急性胆囊炎患者行腹腔镜胆囊切除术的病例资料;按发病到施行手术时间分为4组:72h内为A组(262例),72h^96h为B组(28例),96h^1周为C组(72例),1周~2周为D组(40例);通过比较4组间手术时间、出血量、术后住院时间、总住院时间、中转率和并发症发生率的差异,分析最佳手术时机。统计学采用单因素方差分析、LSD-t检验分析、Pearson Chi-Square检验或连续校正或Fisher确切概率。结果成功施行LC340例,中转开腹62例;发生并发症20例。A、B、C、D组手术时间分别为(40.2±10.3)、(44.1±11.7)、(75.4±12.4)、(112±11.9)min,A、B组无统计学差异(P=0.331),与C、D组有统计学差异(P=0.000);出血量分别为(21.8±10.4)、(22.7±10.8)、(55.6±13.2)、(108.9±21.5)ml,A、B组无统计学差异(P=0.423),与C、D组有统计学差异(P=0.000);术后住院时间分别为(4.1±1.3)、(4.4±1.6)、(4.8±2.1)、(4.8±2.3)d,无统计学差异(P=0.873);总住院时间分别为(7.1±1.4)、(7.5±1.9)、(11.2±1.9)、(16.7±2.1)d,A、B组无统计学差异(P=0.416),与C、D组有统计学差异(P=0.000);中转率分别为15.3%、17.9%、15.3%、15.0%,无统计学差异(P=0.987);并发症发生率3.1%、7.1%、6.9%、12.5%,无统计学差异(P=0.261)。结论急性胆囊炎发病96h内施行LC为最佳时机,手术时间及总住院时间较短,出血量较少。Obejective To explore the optimal operative timing of laparoscopic cholecystectomy for acute cholecystitis.Methods To retrospectively review and analyze 402 patients with acute cholecystitis undergoing laparoscopic cholecystectomy from January 2005 to January 2013.The patients were divided into four groups by duration of the disease：≤72 h（group A,n =262）,72h ～96h （group B,n =28）,96h ～ 1 week （group C,n =72）,1 week ～ 2weeks （group D,n =40）.Patients＇ s operation time,intraoperative blood loss,pperative stay,total hospital stay,conversion rate and complications were analyzed and compared between four groups.Statistical analysis was done by One-way ANOVA,LSD-t test,Pearson Chi-Square test or Yates＇ correction or Fisher＇ ostos exact probabilities.Results LC was completed successfully in 340 patients and the other 62 cases were converted to open cholecystectomy.Complications occurred in 20 patients.No significant difference in postoperative stay,conversion rate and complications among the four groups[group A（4.1 ± 1.3）d、15.3% 、3.1% ;group B（4.4 ± 1.6） d、17.9% 、7.1% ; group C（4.8 ± 2.1）d、15.3% 、6.9% ; group D（4.8 ± 2.3）d、15.0%、12.5%; P 〉 0.05].Operation time,intraoperative blood loss and total hospital stay were no significant difference between group A and group B [group A：（40.2 ± 10.3） min,（21.8 ± 10.4） ml,（7.1 ± 1.4） d; group B：（44.1 ± 11.7） min,（22.7 ± 10.8） ml,（7.5 ± 1.9） d; P 〉 0.05.].But there were significant difference contrasted to group C and group D [group C：（75.4±12.4）min,（55.6±13.2）ml,（11.2±1.9）d; group D：（112±11.9）min,（108.9 ±21.5）m1,（16.7 ±2.1）d; P〈 0.05].Conclusions The optimal operative timing of laparoscopic cholecystectomy for acute cholecystitis is within 96 hours after onset.LC is safe with shorter operation time,less intraoperative blood loss and reduced total hospital stay during this period.

关 键 词：急性胆囊炎 腹腔镜胆囊切除术 手术时机 

分 类 号：R657.4[医药卫生—外科学]