不同时间窗下腹腔镜胆囊切除术治疗老年急性胆囊炎的临床观察  

Clinical observation of laparoscopic cholecystectomy under different time windows in the treatment of acute cholecystitis in the elderly

作　　者：张勇[1] 毛正发[2] ZHANG Yong;MAO Zhengfa(Department of Hepatobiliary Surgery,Affiliated Hospital of Jiangsu University,Jiangsu Province,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院肝胆外科,江苏镇江212001 [2]江苏大学附属医院胃肠外科,江苏镇江212001

出　　处：《临床外科杂志》2020年第8期728-731,共4页Journal of Clinical Surgery

基　　金：江苏省医学青年人才资助项目(QNRC2016838、QNRC2016839)。

摘　　要：目的研究不同时间窗下腹腔镜胆囊切除术治疗老年急性胆囊炎的临床效果。方法急性胆囊炎病人72例,按照其不同手术时机分为前期组(≤3 d)、中期组(>3 d且≤7 d)和后期组(>7 d),每组各24例,三组均行腹腔镜胆囊切除术,比较三组围手术期相关指标及术后并发症,同时比较三组手术前后应激指标及免疫功能。结果三组手术时间、术中出血量、肛门首次排气时间、术后首次下床时间、住院时间比较:早期组<中期组<晚期组,差异有统计学意义(P<0.05)。三组手术后C-反应蛋白(CRP)水平组间比较早期组<中期组<晚期组,差异有统计学意义(P<0.05)。三组手术后免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平组间比较早期组>中期组>晚期组,差异有统计学意义(P<0.05)。早期组、中期组、晚期组并发症总发生率分别为16.67%、29.17%、37.50%,差异无统计学意义(P>0.05)。结论急性胆囊炎病人尽早进行腹腔镜胆囊切除术可降低手术出血量,减轻机体应激反应,加快病人术后恢复。Objective To study the Clinical observation of laparoscopic cholecystectomy under different time windows in the treatment of acute cholecystitis in the elderly.Methods The clinical data of 72 patients with acute cholecystitis in our hospital in recent years were analyzed retrospectively.According to the different operation time,they were divided into three groups:early group(≤3 d),middle group>3 d and≤7 d)and late group(>7 d),24 cases in each group,all of them underwent laparoscopic cholecystectomy,The perioperative indexes and postoperative complications of the three groups were compared,and the stress indexes and immune function of the three groups before and after operation were compared.Results The operation time,intraoperative bleeding volume,first anal exhaust time,first time out of bed after operation and hospitalization time of the three groups were significantly different,early group<metaphase group<late group(P<0.05).The level of C-reactive protein(CRP)in the three groups after operation was lower than that in the early group,early group<metaphase group<late group(P<0.05).The levels of IgA,IgG and IgM in the three groups were significantly higher than those in the early group,the middle group and the late group,early group>middle group>late group(P<0.05).The total incidence of complications in early group,middle group and late group were 16.67%,29.17%and 37.50%,respectively,with no significant difference(P>0.05).Conclusion Early laparoscopic cholecystectomy in patients with acute cholecystitis can reduce the amount of bleeding,reduce the body’s stress response,and speed up the recovery of patients.

关 键 词：老年 不同时间窗 腹腔镜胆囊切除术 急性胆囊炎 

分 类 号：R657.41[医药卫生—外科学]