急性胆囊炎腹腔镜手术时机选择(附647例分析)

Timing of laparoscopic cholecystectomy for acute cholecystitis:an analysis of 647 cases

目的探讨急性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的治疗时机。方法回顾性分析2005年1月至2010年1月哈尔滨医科大学附属第四医院普通外科647例急性胆囊炎行腹腔镜胆囊切除术的临床资料。结果按急性胆囊炎发病至手术时间分为早期手术组(3d内),延期手术组(3d至3周)及择期手术组(3周以上)。延期手术组术中出血量、手术时间多于早期与择期手术手术组(P<0.05)。各组间并发症发生率差异无统计学意义。早期手术组累计住院时间3～23d(平均5.5d),累计经济费用0.6万～1.9万元(平均1.1万元)。延期手术组累计住院时间3～28d(平均7.5d),累计经济费用0.8万～2.4万元(平均1.5万元)。择期手术组累计住院时间6～45d(平均11.7d),累计经济费用1.5万～3.6万元(平均2.3万元)。随病程的延长早期手术组、延期手术组、择期手术组累计住院时间及经济费用逐渐增加(P<0.05)。结论急性胆囊炎尽早施行LC可降低手术费用、提高生活质量,无论病程长短,一经诊断应尽早施行LC。

Objective To explore the optimal timing for laparoscopic cholecystectomy （LC） in patients with acute cholecystitis. Methods The clinical data of 647 patients with acute cholecystitis performed laparoscopic cholecystectomy from January 2005 to January 2010 in the Department of General Surgery, the Fourth Hospital of Harbin Medical University were analyzed retrospectively. Results According to the interval, 647 patients were divided into 3 groups. The patients in the first （n=212）, second （n=238） and third （n=197） group performed LC were within 72h, during 72h-3w, and beyond 3w, respectively. There was no significant difference among 3 groups. Mean operative time and blood losses in the second group were more than those in the first and the third group significantly（P〈0.05）. There was no significant difference in postoperative complication among 3 groups. Postoperative stay was 3-23 days （mean 5.5）, 3-28 days （mean 7.5）, 6-45days （mean 11.7） in the first, second and third group, respectively. The cost was RMB 6-19 thousand yuan （mean 11 thousand）, 8-24 thousand yuan （mean 15 thousand）, 15-36 thousand yuan （mean 23 thousand） in the first, second and third group, respectively. The postoperative stay and cost in the first, second and third group were increased gradually. Conclusion The timing for LC in patients with acute cholecystitis should be within the shortest interval after onset of symptoms no matter whether the interval is within 72 h or not. On average early laparoscopic cholecystectomy is less expensive and results in better quality of life.