发病72 h以上老年急性胆囊炎的手术时机探索  

Exploration of surgical timing for acute cholecystitis in elderly patients with onset exceeding 72 h

作　　者：李涛[1] 董鼎辉[2] 杨刚 李腾 李胜 郝琪伟 张雄 张鑫[1] LI Tao;DONG Dinghui;YANG Gang;LI Teng;LI Sheng;HAO Qiwei;ZHANG Xiong;ZHANG Xin(No.2 Ward of General Surgery Department,Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Yulin 719000;No.3 Ward of Hepatobiliary Surgery Department,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院榆林医院普通外科二病区,陕西榆林719000 [2]西安交通大学第一附属医院肝胆外科三区,陕西西安710061

出　　处：《临床医学研究与实践》2023年第34期36-39,共4页Clinical Research and Practice

基　　金：陕西省重点研发计划项目(No.2019ZDLSF03-04)。

摘　　要：目的探讨发病72 h以上老年急性胆囊炎的手术时机。方法回顾性选取2017年7月至2019年12月行腹腔镜胆囊切除术治疗的98例老年急性胆囊炎(发病时间>72 h)患者为研究对象,根据治疗时机不同将其分为急诊手术组(A组,56例)和延期手术组(B组,42例)。比较两组的治疗效果。结果A组的手术时间长于B组,术中出血量多于B组(P<0.05)。两组的中转开腹率、术后并发症总发生率比较,差异无统计学意义(P>0.05)。术前、术后1 d,B组的白细胞介素-6(IL-6)和C反应蛋白(CRP)水平均低于A组(P<0.05)。术后1、6个月,A组的消化病生存质量指数(GLQI)评分高于B组(P<0.05)。结论对发病72 h以上可耐受手术的老年急性胆囊炎患者而言,早期积极手术治疗并未增加术后并发症及延长住院时间,还可改善生活质量;延期手术中,早期的穿刺引流能改善胆囊局部炎症情况,缩短手术时间,减少出血量,有利于后期择期手术操作。Objective To discuss the surgical timing for acute cholecystitis in elderly patients with onset exceeding 72 h.Methods Ninety-eight elderly patients with acute cholecystitis(onset time>72 h)who underwent laparoscopic cholecystectomy from July 2017 to December 2019 were retrospectively selected as the study objects and divided into emergency operation group(group A,56 cases)and delayed operation group(group B,42 cases)according to different treatment timing.The therapeutic effects of the two groups were compared.Results The operative time of the group A was longer than that of the group B,and the intraoperative blood loss was more than that of the group B(P<0.05).There were no significant differences in the rate of conversion to open laparotomy and the total incidence of postoperative complications between the two groups(P>0.05).Before and 1 d after operation,the interleukin-6(IL-6)and C-reactive protein(CPR)levels in the group B were lower than those in the group A(P<0.05).At 1 and 6 months after operation,the Gastrointestinal Quality of Life Index(GLQI)score of the group A was higher than that of the group B(P<0.05).Conclusion For elderly patients with acute cholecystitis who can tolerate surgery after more than 72 h of onset,early active surgical treatment does not increase postoperative complications and prolong hospital stay,but can improve the quality of life;in delayed operation,early puncture and drainage can improve the local inflammation of gallbladder,shorten the operation time,reduce the blood loss,and is conducive to later selective operation.

关 键 词：急性胆囊炎 腹腔镜胆囊切除术 手术时机 

分 类 号：R657.4[医药卫生—外科学]