急性结石性胆囊炎腹腔镜手术的最佳时机及中转开腹的影响因素  

The best chance of laparoscopic surgery for acute calculous cholecystitis and the relative factors for conversion to lapatotomy

作　　者：付旭军 胡庆华 程金儒 李富华 孙金宇 焦兴元[2] 

机构地区：[1]香河县人民医院,河北香河065400 [2]中山大学附属第一医院肝胆外科,广东广州510080

出　　处：《西部医学》2015年第7期999-1001,共3页Medical Journal of West China

基　　金：国家自然科学基金(81071984)

摘　　要：目的探讨腹腔镜手术治疗急性结石性胆囊炎的最佳时机及中转开腹的相关因素。方法以2010年3月~2012年3月收治的121例进行腹腔镜胆囊切除术的急性结石性胆囊炎患者为研究对象。根据症状出现距手术治疗时间的长短进行分组,其中时间〈48h的患者为A组42例;时间为48~72h的患者为B组35例;时间〉72h的患者为C组23例;时间为2~4周的患者为D组21例。对各组患者的手术时间、中转开腹率、并发症发生率及相关因素进行比较。结果 A组手术时间最短,中转开腹率最低。C组手术时间最长,中转开腹率最高。差异有统计学意义（P〈0.05）。四组患者术后并发症发生率不存在明显差异性,无统计学意义（P〉0.05）。患者体温、胆囊肿大、白细胞计数、胆囊壁厚度、是否胆囊颈部结石嵌顿以及手术时机6个因素与术中中转开腹率有关,差异有统计学意义（P〈0.05）。结论对急性结石性胆囊炎患者,在临床症状出现后48h内进行手术治疗为最佳时机,能有效减少手术时间,降低中转开腹率。Objective To analyze and study the time of laparoscopic surgery for acute calculous cholecystitis and the relative factors for conversion to lapatotomy.Methods 121 patients with acute calculous cholecystitis were selected for the study.They were grouped according to the time from symptom onset to surgery.The time48hwas group A,the time from 48-72 hwas group B and the time72hwas group C.The time from 2weeks to 4weeks was group D.The time of surgery,the incidence of conversion to lapatotomy,the incidence of complications and the relative factors for conversion to lapatotomy were observed and compared between four groups.Results The time of surgery was shortest in group A and longest in group C.The incidence of conversion to lapatotomy was lowest in group A and highest in group C.The difference was significant（P〈0.05）and the incidence of complications had no significant difference between four groups（P〉0.05）.The relative factors for conversion to lapatotomy during operation included the temperature of patients,operation timing,gall-bladder wall thickening,gallbladder enlargement and leucocyte count.Conclusion The time within 48 hfrom symptom to surgery is the best operation timing for acute calculous cholecystitis.The operation time,the temperature of patients and leucocyte count are the relative factors for the incidence of conversion laparotomy.

关 键 词：急性结石性胆囊炎 腹腔镜手术 手术时机 中转开腹率 

分 类 号：R575.6[医药卫生—消化系统]