腹腔镜胆囊切除术治疗急性结石性胆囊炎术中中转开腹的影响因素分析  

The best opportunity and the influencing factors of laparoscopic cholecystectomy transfering to laparotomy in treatment of acute calculous cholecystitis

作　　者：苗江雨[1] 董耀[1] 郭炳勋[1] 郭爱霞[1] 张静[1] 刘伟[1] MIAO Jiangyu;DONG Yao;GUO Bingxun(Department of General Surgery,The Third Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第三医院普外科,050011

出　　处：《河北医药》2020年第19期2905-2908,2913,共5页Hebei Medical Journal

摘　　要：目的探讨腹腔镜下胆囊切除术治疗急性胆囊炎的最佳时机以及影响中转开腹的因素。方法选择收治的急性结石性胆囊炎患者160例,根据手术时机分为4组。其中从急性发作到手术时间≤48 h为甲组、从急性发作到手术时间48~72 h为乙组、从急性发作到手术时间≥72 h为丙组。丁组患者为经过严格的术前对症保守治疗后择期进行腹腔镜胆囊切除术,分析4组患者的术中及术后相关临床结局。结果甲组及丁组患者失血量及中转开腹率较乙、丙组患者明显减少,差异有统计学意义(P<0.05),体温、右上腹肌紧张、白细胞计数、触及胆囊、总胆红素、谷丙转氨酶、谷草转氨酶、胆囊颈部结石嵌顿、胆囊壁的厚度及手术时机均与中转开腹有关(P<0.05),右上腹肌紧张、白细胞计数、胆囊颈部结石嵌顿以及手术时机是中转开腹的独立危险因素(OR=1.853、1.012、1.237、0.146,P<0.05)。结论急性结石性胆囊炎在发作48 h内是腹腔镜手术治疗最佳时机,术中中转开腹受到右上腹肌紧张、白细胞计数、胆囊颈部结石嵌顿以及手术时机影响,应避免以上危险因素进而提高腹腔镜手术成功率。Objective To investigate the best opportunity and the influencing factors of laparoscopic cholecystectomy transfering to laparotomy in treatment of acute calculous cholecystitisthe.Methods A total of 160 patients with acute calculous cholecystitisthe were enrolled in the study.According to the operation time,these patients were divided into four groups,in which,the time from acute attack to operation starting in group A,group B,group C was 48h,72h,more than 72h,respectively.The patients in group D were treated by strict preoperative symptomatic therapy,then who underwent time-selecting laparoscopic cholecystectomy.The related factors and clinical ontcomes of patients were observed and compared among the four groups.Results The intraoperative blood loss and the rates of tarnsfering to open surgery in group A and group D were significantly less than those in group B anf group C(P<0.05).Moreover the operative time,drainage volume and complications in group A and group D were significantly less than those in group B anf group C(P<0.05).In addition the patient’s body temperature,upper abdominal muscle tension,white blood cell counts,total bilirubin,alanine transaminase,glutamic oxalacetic transaminase,the thickness of gallbladder wall and gall bladder neck calculus incarceration were correlated with transfering laparotomy(P<0.05).And upper abdominal muscle tension,white blood cell count,the gallbladder neck calculus incarceration and operation time were independent risk factors of laparoscopic cholecystectomy transfering to laparotomy in treatment of acute calculous cholecystitis(P<0.05).Conclusion It is the best opportunity for laparoscopic cholecystectomy in treatment of acute calculous cholecystitis that the attack time of acute calculous cholecystitis is within 48h.The influencing factors of open surgery are right upper abdominal muscle tension,white blood cell count,the gallbladder neck calculus incarceration and operation time,therefor,these factors mentioned above should be avoided,so as to improve the succes

关 键 词：急性结石性胆囊炎 腹腔镜 胆囊切除术 中转开腹 

分 类 号：R575.61[医药卫生—消化系统]