急性结石性胆囊炎患者腹腔镜手术时机选择及中转开腹的影响因素  

Selection of the time of laparoscopic surgery and the factors influencing the conversion of laparotomy in patients with acute calculous cholecystitis

作　　者：张崇亮 ZHANG Chongliang(Department of General Surgery,Shenyang Emergency Center,Shenyang,Liaoning,110006,China)

机构地区：[1]沈阳急救中心普外科,辽宁沈阳110006

出　　处：《当代医学》2021年第23期95-97,共3页Contemporary Medicine

摘　　要：目的探讨急性结石性胆囊炎患者腹腔镜手术时机选择及中转开腹的影响因素。方法回顾性分析2018年10月至2019年11月本院收治的105例行腹腔镜手术的急性结石性胆囊炎患者的临床资料,根据发病至手术用时分为早期组(n=53)和晚期组(n=52)。早期组发病至手术用时<48 h,晚期组发病至手术用时≥48 h。比较两组患者手术相关指标、并发症发生率及中转开腹情况,并采用单因素、多因素分析急性结石性胆囊炎患者腹腔镜手术中转开腹的影响因素。结果早期组手术时间短于晚期组,术中失血量少于晚期组,差异均有统计学意义(P<0.05);两组并发症发生率、中转开腹率比较差异无统计学意义。多因素Logistic回归分析显示,年龄≥60岁、WBC计数>15×10^(9)/L、胆囊壁厚度≥5 mm为影响患者中转开腹的独立危险因素(P<0.05)。结论急性结石性胆囊炎患者发作后48 h内行腹腔镜胆囊手术更利于缩短手术时间、降低术中出血量,但对于年龄≥60岁、WBC计数>15×10^(9)/L、胆囊壁厚度≥5 mm的患者应制定预防措施以减少中转开腹。Objective To investigate the choice of laparoscopic surgery and the factors influencing the laparotomy in patients with acute calculous cholecystitis.Methods The clinical data of 105 cases of acute calculous cholecystitis treated in our hospital from October 2018 to November 2019 were retrospectively analyzed.They were divided into early group(n=53)and late group(n=52)depending on the onset of the disease to the time of surgery.The time from onset to operation in the early group was<48 h,and the time from onset to operation in the late group was≥48 h.The operative indexes,complications and transect of laparotomy between the two groups at advanced stage were compared.Single factor and multiple factors were used to analyze the influencing factors of laparotomy in patients with acute calculous cholecystitis.Results The operation time in the early group was shorter than that in the late group,intraoperative blood loss was less than in the early group,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of complications and the rate of conversion to open abdomen were compared.Regression analysis Logistic multiple factors showed that age≥60 years,WBC count>15×10^(9)/L,cystic wall thickness≥5 mm were independent risk factors affecting the patient's transition to open abdomen(P<0.05).Conclusion Laparoscopic cholecystectomy 48 h after the onset of acute calcu-lous cholecystitis is more beneficial to shorten the operation time and reduce the amount of intraoperative bleeding,Nevertheless,attention should be paid to the development of preventive measures to reduce the transfer of open abdomen for patients≥60 years,WBC count 15×10^(9)/L,cystic wall thickness≥5 mm.

关 键 词：急性结石性胆囊炎 腹腔镜 手术时机 中转开腹 因素 

分 类 号：R657.4[医药卫生—外科学]