急性胆囊炎患者的急诊腹腔镜胆囊切除术

Emergent laparoscopic cholecystectomy for acute cholecystitis

目的比较对于急性胆囊炎患者行急诊腹腔镜胆囊切除术(ELC)、早期保守治疗和延期腹腔镜胆囊切除术(DLC)的优劣。方法回顾性分析2002年4月～2005年10月接受ELC及DLC手术的急性胆囊炎患者共126例。结果两组患者在平均手术时间、平均麻醉时间、术后住院时间等方面差异均无显著性(P>0.05),而在总住院时间、术后并发病及总体费用方面,ELC较DLC均显示有明显的优势(P<0.05)。结论对于急性胆囊炎患者,早期诊断,在发病72h内施行急诊腹腔镜胆囊切除术不论从可操作性、安全性,还是从费用上均可比于甚至优于延期腹腔镜手术。

[Objective] To compare the efficacy of emergent laparoscopic cholecystectomy （ELC） with that of conservative treatment followed by delayed laparoscopic cholecystectomy （DLC） in the management of acute cholecystitis. [Methods] A total of 126 acute cholecystitis patients who received ELC（ELC group） or DLC （DLC group） between April 2002 and October 2005 were retrospectively compared. The demographic data, surgical variables, hospital stay and complication rate were evaluated. [Results] Demographic data, average operating time and anesthesia time, postoperative hospital stay time were comparable between the two groups （P 〉0.05）, while the total hospital stay is shorter, postoperative complications fewer and global cost lower in the ELC group（P 〈0.05）. [Conclusions] Early diagnosis and ELC within the 72 hours from the onset of symptoms should be advocated for the treatment of acute cholecystitis.