不同手術(shù)時(shí)機(jī)腹腔鏡膽囊切除術(shù)治療急性結(jié)石性膽囊炎的效果比較

李文第 包漢康

[摘要]目的 探究不同手術(shù)時(shí)機(jī)腹腔鏡膽囊切除術(shù)治療急性結(jié)石性膽囊炎的效果。方法 回顧性分析我院2016年2月～2017年2月應(yīng)用腹腔鏡切除術(shù)治療的82例急性結(jié)石性膽囊炎患者資料，將其按照不同的手術(shù)時(shí)機(jī)分為A組（44例，在發(fā)病72 h予以腹腔鏡膽囊切除術(shù)治療）、B組（38例，在發(fā)病超過72 h內(nèi)予以腹腔鏡膽囊切除術(shù)治療），分析治療結(jié)果。結(jié)果 A組術(shù)后排氣時(shí)間、平均住院時(shí)間均短于B組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。A組患者的并發(fā)癥發(fā)生率均低于 B組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。A組患者的中轉(zhuǎn)開腹率[2.27%（1/44）]低于B組[15.79%（6/38）]，差異有統(tǒng)計(jì)學(xué)意義（χ2=4.771，P=0.029<0.05）。結(jié)論 急性結(jié)石性膽囊炎患者在發(fā)病72 h內(nèi)予以腹腔鏡膽囊切除術(shù)治療，并發(fā)癥少，安全性高，可促進(jìn)患者術(shù)后恢復(fù)，降低中轉(zhuǎn)開腹率。

[關(guān)鍵詞]腹腔鏡膽囊切除術(shù)；急性結(jié)石性膽囊炎；手術(shù)時(shí)機(jī)；并發(fā)癥

[中圖分類號(hào)] R656 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2018）5（c）-0040-03

Effect comparison of laparoscopic cholecystectomy for the treatment of acute calculous cholecystitis at different operation timing

LI Wen-di BAO Han-kang

Department of the First Surgery，the Second People′s Hospital of Huidong County in Guangdong Province，Huidong 516351，China

[Abstract]Objective To explore the results of laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis at different operation times.Methods The data of 82 patients with acute calculous cholecystitis undergone laparoscopic resection in our hospital from February 2016 to February 2017 were retrospectively analyzed.They were grouped according to different surgical timings.In group A （n=44），the surgery was performed within 72 hours after onset，while in group B （n=38），the laparoscopic cholecystectomy was performed over 72 hours after onset.The therapeutic effect was analyzed.Results The postoperative exhaust time and average hospitalization time in group A were shorter than those in group B，the differences were statistically significant （P<0.05）.The complication rates of patients in group A were lower than those in group B，and the difference was statistically significant （P<0.05）.The conversion rate to laparotomy of patients in group A was （2.27%[1/44]） lower than that in group B （15.79%[6/38]），and the difference was statistically significant（χ2=4.771，P=0.029<0.05）.Conclusion For patients with acute calculous cholecystitis，performace of laparoscopic cholecystectomy within 72 hours of onset has advantages of few complications，high safety，promotion of postoperative recovery，and decrease of conversion to laparotomy rate.

[Key words]Laparoscopic cholecystectomy；Acute calculous cholecystitis；Operation timing；Complications

急性結(jié)石性膽囊炎是臨床一種急性炎癥，主要是由結(jié)石將膽囊管阻塞，導(dǎo)致膽汁在膽囊內(nèi)滯留，進(jìn)而引發(fā)細(xì)菌感染，造成該疾病的發(fā)生[1]。急性結(jié)石性膽囊炎手術(shù)治療是臨床的首選治療方式[2]。隨著腹腔鏡的完善，腹腔鏡膽囊切除術(shù)已經(jīng)成為該疾病的重要治療方式之一，并取得顯著的療效，得到患者的一致認(rèn)可，但是關(guān)于手術(shù)時(shí)機(jī)選擇尚未給出明確的定論。本研究回顧性分析82例應(yīng)用腹腔鏡膽囊切除術(shù)治療患者的資料，并將不同的手術(shù)時(shí)機(jī)分組，現(xiàn)將結(jié)果報(bào)道如下。

1 資料與方法

1.1 一般資料

選取2016年2月～2017年2月我院的82例應(yīng)用腹腔鏡切除術(shù)治療急性結(jié)石性膽囊炎患者，按照不同的手術(shù)時(shí)機(jī)分為A組（44例）、B組（38例），上述患者對(duì)本次研究內(nèi)容均明確，簽署知情同意書，且該研究經(jīng)過醫(yī)院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn)通過。A組：男27例，女17例；年齡22～67歲，平均（48.7±2.6）歲；結(jié)石平均大小（2.2±0.3）cm。……