急性结石性胆囊炎早期腹腔镜手术的可行性及手术方法探讨

The discussion on feasibility and appropriate method of laparoscopic cholecystectomy in early stage of acute calculous cholecystitis

目的:探讨急性结石性胆囊炎患者症状发作72h内行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及合理的手术方法。方法:回顾分析136例急性结石性胆囊炎患者的临床资料,并与同期行LC治疗1 165例非急性发作期胆囊结石患者在手术时间、并发症发生率及中转开腹率等方面比较。结果:136例早期行LC的急性结石性胆囊炎患者平均手术时间、并发症发生率及中转开腹率与同期行LC治疗的1 165例非急性发作期胆囊结石患者差异无统计学意义(P>0.05)。结论:急性结石性胆囊炎在症状发作72h内行LC是安全可行的。手术成功的关键是Calot三角的正确处理,减少并合理处理术中出血是降低肝外胆管损伤和中转开腹率的重点。

Objective：To investigate the feasibility and appropriate method of laparoscopic cholecystectomy in early stage of acute calculous cholecystitis.Methods：The data of 136 patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis in early stage were retrospectively analyzed,compared with the data of 1 165 patients,who got cholecystolithiasis and underwent LC in non-acute stage,on operative time,postoperative complications and the rate of conversion to open surgery.Results：There were no significant differences between two groups in all the parameters observed above（P〉0.05）.Conclusions：Laparoscopic cholecystectomy is safe and feasible for acute calculous cholecystitis within 72h after acute attack,and dealing with Calot＇s triangle correctly is crucial.Decreasing and dealing with haemorrhage properly is very important in reducing the rate of damage to extrahepatic duct and conversion to laparotomy.