早期和延迟胆囊切除术对轻度急性胆管炎的疗效比较  

Treatment outcomes of early versus delayed cholecystectomy for acute cholangitis

作　　者：杨勇 沈章义 龚勇[2] YANG Yong;SHEN Zhangyi;GONG Yong(Department of General Surgery,Wuhan Jingdu Lithiasis Urology Hospital,Wuhan 430000,China)

机构地区：[1]武汉京都结石泌尿外科医院普通外科,武汉430000 [2]武警湖北省总队医院普外科

出　　处：《中国感染与化疗杂志》2022年第1期34-38,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨不同时期胆囊切除术在轻度急性胆管炎患者治疗中的应用效果。方法采用回顾性队列研究,收集2017年7月—2019年10月于武汉京都结石泌尿外科医院普通外科收治的289例轻度急性胆管炎患者的临床资料,通过病例筛选最终获得入组患者96例,根据选择胆囊切除术的时期不同分为2组,其中A组(n=48)为采用同次住院期间行手术接受胆囊切除术治疗,B组(n=48)为急性胆管炎好转出院1个月后再次入院行手术者。对比两组病例的基本资料(年龄、性别),术中中转开腹率、手术时间、术中出血量、肛门排气时间、住院时间、手术并发症、胆道相关事件,实验室指标,患者治疗效果及随访复发情况。结果在肛门排气时间方面,A组平均时间为(21.4±4.3)h,B组平均时间为(18.6±2.5)h,差异有统计学意义(P<0.05);在患者住院时间方面,A组患者住院时间为(3.5±2.2)d,B组患者住院时间为(2.9±1.2)d,差异有统计学意义(P<0.05)。其他相关指标两组未见差异有统计学意义。结论胆囊切除术对轻度急性胆管炎治疗有效。在促进排气和缩短术后住院时间上,延迟胆囊切除术较早期胆囊切除术效果更好。Objective To investigate the outcomes of laparoscopic cholecystectomy(LC)in the treatment of acute cholangitis.Methods A retrospective cohort study was conducted in 289 patients with acute cholangitis,who were treated from July 2017 to October 2019 in department of general surgery,Wuhan Jingdu Lithiasis Urology Hospital.Finally,96 patients were eligible for inclusion into this analysis.The patients were assigned to group A(n=48)if they received the surgery early during the hospital admission for acute cholangitis,or group B(n=48)if they received the surgery later(i.e.,readmission for the surgery 1 month after discharge from hospital following improvement of acute cholangitis.Demographic data(age,sex),intraoperative conversion to laparotomy,operation time,intraoperative bleeding,the time to anal exhaust,hospital stay,surgical complications,biliary related events,and laboratory tests,treatment outcomes,and recurrence were compared between the two groups.Results The average time to anal exhaust was(21.4±4.3)h in group A,and(18.6±2.5)h in group B(P<0.05).The length of hospital stay was(3.5±2.2)days in group A,significantly longer than that in group B[(2.9±1.2)days](P<0.05).No significant difference was found in other relevant outcome measures.Conclusions Cholecystectomy is effective in the treatment of mild acute cholangitis.Delayed cholecystectomy is more effective than early cholecystectomy in promoting anal exhaust and shortening postoperative hospital stay.

关 键 词：急性胆管炎 胆囊切除术 手术疗效 

分 类 号：R575.7[医药卫生—消化系统]