急性结石性胆囊炎手术时机的探讨  

The Operation Timing of Acute Calculous Cholecystitis

作　　者：凌干 朱岭[2] 翁方泽 王丕晓 LING Gan;ZHU Ling;WENG Fangze;WANG Pixiao(School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;Department of Hepatobiliary and Pancreatic Surgery,The Central Hospital of Wuhan,Wuhan 430014,Hubei,China)

机构地区：[1]江汉大学医学部,湖北武汉430056 [2]武汉市中心医院肝胆胰外科,湖北武汉430014

出　　处：《江汉大学学报(自然科学版)》2025年第1期44-49,共6页Journal of Jianghan University:Natural Science Edition

摘　　要：目的抗感染治疗联合同期行腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)是治疗急性结石性胆囊炎的首选方式,但手术时机的选择一直存在争议。本研究目的在于对这类病人的手术时机进行探讨。方法回顾性分析了349例被诊断为急性结石性胆囊炎并行LC患者的资料,根据从出现症状到实施手术的时间间隔将患者分为3组:A组0~3 d(n=121),B组4~7 d(n=170),C组8~14 d(n=58)。分析比较各组间患者的一般资料、手术时间、住院时间、手术费用、总费用以及并发症发生率和病死率。结果349例患者中仅B组有4例中转开腹的,其余两组均无中转病例,组间中转率差异无统计学意义(P=0.104);19例出现并发症的患者,各组间并发症发生率差异无统计学意义(P>0.05)。三组之间在手术时间、住院时间上差异均有统计学意义(P<0.001),随着症状持续时间的增加,患者手术时间和住院时间显著增加。A组手术费用显著低于B组(P<0.001)和C组(P<0.001),C组手术费用高于B组,但差异无统计学意义(P=0.296)。A组总费用显著低于B组(P<0.001)和C组(P<0.001),C组总费用高于B组,但差异无统计学意义(P=0.337)。结论急性结石性胆囊炎手术在3 d内效果最佳,在此阶段行LC能缩短手术时间和住院时间,并且减轻了患者的经济负担。对于症状持续时间较长超过3 d甚至7 d的患者也推荐尽早手术治疗,但建议由经验丰富的医生主刀手术。Objective Anti-infection therapy combined with concurrent laparoscopic chole⁃cystectomy(LC)is the preferred treatment for acute calculous cholecystitis,but the operation timing has been controversial.This study aims to explore the operation timing in such patients.Methods A retrospective analysis was conducted on the records of 349 patients who underwent LC for acute calculous cholecystitis.The patients were divided into three groups based on the interval from the onset of symptoms to surgery:Group A(0-3 days,n=121),Group B(4-7 days,n=170),and Group C(8-14 days,n=58).The parameters examined included demographic information,operation time,length of hospital stay,surgical cost,total cost,complication rates,and mortality across the three groups.Results Among the 349 patients,only 4 patients in group B were converted to laparotomy,while there were no conversion cases in the other two groups.There was no statistically significant difference in conversion rate between the three groups(P=0.104).Similarly,complications occurred in 19 patients,and there was no statistical difference in the incidence of complications between the three groups(P>0.05).There were statistical differences between the three groups in operation time and length of hospital stay(P<0.001),and the operation time and length of hospital stay increased significantly with the duration of symptoms.The surgical cost in Group A was significantly lower than in Group B(P<0.001)and Group C(P<0.001).The surgical cost in Group C was higher than in Group B,but there was no statistical difference(P=0.296).The total cost in Group A was significantly lower than in Group B(P<0.001)and Group C(P<0.001).The total cost in Group C was higher than in Group B,but there was no statistical difference(P=0.337).Conclusion Acute calculous cholecystitis surgery has the best effect within 3 days.During this period,LC can shorten the operation time and length of hospital stay,and reduce the economic burden of patients.Early surgery is also recommended for patients with prolonged

关 键 词：急性结石性胆囊炎 手术时机 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]