急性胆囊炎腹腔镜胆囊切除术133例治疗体会

Experience with the treatment of laparoscopic cholecystectomy for 133 patients with acute cholecystitis

目的探讨急性胆囊炎（AC）急性发作72h内和72h后行急诊腹腔镜胆囊切除术（LC）的优缺点。方法回顾性分析2（）04年2月到2008年8月收治的133例AC行急诊LC的病人，其中急性发作72h内手术者（A组）34例，急性发作72h后手术者（B组）99例。结果两组病例性别、年龄结构相当，各病理类型组内比例亦相当。133例全部完成LC，无中转开腹、胆漏及胆道损伤等并发症，无死亡及术后30d再入院病例。A组的手术时间为（44．1±5．32）min，总住院时间为（7．50±1．41）d均显著短于B组的（66．4±3．05）min和（12．1±1．25）d，且差异均有统计学意义（P〈0．01）；两组术后住院时间分别为（6．50±1．31）d和（6．67±0．73）d；切口感染率分别为2．94％（1／34）和2．02％（2／99），差异均无统计学意义；两组住院费用分别为（6692±794）元和（8378±802）元，差异有统计学意义（P〈0．01）。结论对于有经验的医生，AC行急诊LC，一次住院即可治愈病人。急性发作72h后行急诊LC较急性发作72h内行LC难度增大，但并未增加手术并发症及延长术后住院时间，仍不失为有效的治疗方法。急性发作72h后行急诊LC总住院时间延长及费用增高与术前住院时间延长及术前用药有关。

Objective To assess the clinical outcomes,possible advantages and disadvantages of early versus delayed laparoseopic cholecystectomy （LC） for acute choleeystitis （AC）. Methods A to- tal of 133 patients presenting as an emergency due to AC from February 2004 to August 2008, who then underwent LC were retrospectively studied. Outcomes were compared between those who under- went LC for AC within 72 hours （early group） and after 72 hours （delayed group） of presentation. There were 34 patients in early group versus 99 in delayed group. Results There were no intergroup differences in age,gender,or pathologic types of AC. There was no conversion to open cholecystecto- my, biliary leak, no biliary tract injury, other intraoperative or postoperative complications, death and no 30-day readmission rates in either group. Patients undergoing early LC experienced a significantly shor- ter operation time （44. 1± 5.32 versus 66. 4± 3. （15 minutes, P〈0. 01 ） and global in-hospital stay （7.50±1.41 versus 12. 1 ±1.25 days,P〈0. 01 ）. There was no significant difference with postopera- tive stay （6. 50± 1.31 versus 6. 67 ± 0. 73 days, P〈0. 01 ） and wound infection rates （1/34,2. 94 % versus 2/99,2. 02 % ,P〉0. 05）between groups. There was a significant difference with the cost （6692 ±794 versus 8378 ± 802 RMB Yuan, P〈0.01 ） between groups. Conclusion In experienced hands, both early and delayed LC appears to be effective and safe for AC, and can avoid recurrence of AC. De- layed LC may be more difficulty and time-consuming, tends to prolong the total length of hospital stay and increase the cost for preoperative stay, but doesn＇t increase complications and postoperative hospital stay.