急性胆囊炎腹腔镜手术时机的选择

Timing of Laparoscopic Cholecystectomy for Acute Cholecystitis

目的探讨急性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术时机。方法回顾分析2006年7月～2011年3月186例急性胆囊炎行LC的临床资料,根据病程分为3组:病程72 h内为组1(n=81),病程72 h～1周为组2(n=67),病程1～2周为组3(n=38);比较3组中转率、手术时间、术中出血量等。采用四孔法,前后结合解剖Calot三角,顺逆结合切除胆囊,并遵循疑难复杂胆囊结石LC的其他基本原则。结果 LC成功158例,中转开腹28例,中转率15.1%(28/158)。无手术并发症,无死亡病例。组1中转开腹率6.2%(5/81)显著低于组3 36.8%(14/38)(χ2=18.133,P=0.000),但与组2 13.4%(9/67)无统计学差异(χ2=2.257,P=0.133);组2中转开腹率13.4%(9/67)显著低于组3 36.8%(14/38)(χ2=7.768,P=0.005)。组1手术时间(42.6±11.4)min显著短于组2(77.4±12.6)min(q=24.863,P<0.05)和组3(113.9±12.1)min(q=42.784,P<0.05),组2手术时间显著短于组3(q=21.206,P<0.05)。组1出血量中位数20 ml(5～45 ml)显著少于组2 55 ml(30～90 ml)(Z=-6.819,P=0.000)和组3 110 ml(60～145 ml)(Z=-8.367,P=0.000),组2出血量显著少于组3(Z=-5.306,P=0.000)。组1住院时间(6.9±2.2)d显著短于组2(11.3±2.9)d(q=14.762,P<0.05)和组3(18.4±2.6)d(q=32.403,P<0.05),组2住院时间较组3显著缩短(q=19.370,P<0.05)。结论急性胆囊炎72 h以内行LC最佳,手术时间较短,出血量较少,住院时间缩短,中转开腹率较低。

Objective To investigate the timing of laparoscopic cholecystectomy（LC） for acute cholecystitis. MethodsWe retrospectively analyzed the data of 186 patients who received LC for acute cholecystitis from July 2006 to March 2011.The patients were divided into three groups according to the course of the disease： ≤ 72 h（group 1,n=81）,72 h-1 week（group 2,n=67）,and 1-2 weeks（group 3,n=38）.The rate of conversion to open surgery,operation time and intraoperative blood loss were compared among the three groups.All the patients underwent four-port LC.We dissected the Calot＇s triangle and excised the cholecyst abiding by the basic principle for complicated LC. Results LC was completed successfully in 158 of the patients,the other 28 were converted to open surgery（15.1%）.No surgical complications nor death occurred.The rate of conversion to open surgery was 6.2%（5/81） and 13.4%（9/67）（χ2=2.257,P=0.133） in group 1 and 2 respectively,which were both significantly lower than that in the group 3 [36.8%（14/38）,χ2=18.133,P=0.000 and χ2=7.768,P=0.005,respectively].Group 1 showed significantly shorter operation time,less median blood loss,and shorter hospital stay than those in group 2 and 3 [（42.6±11.4） min vs.（77.4±12.6） min（q=24.863,P0.05） and（113.9±12.1） min（q=42.784,P0.05）;20 ml（5-45 ml） vs.55 ml（30-90 ml）（Z=-6.819,P=0.000） and 110 ml（60-145 ml）（Z=-8.367,P=0.000）;and（6.9±2.2） d vs.（11.3±2.9）d（q=14.762,P0.05） and（18.4±2.6） d（q=32.403,P0.05）;respectively],and those in group 2 were also significantly different from those in group 3（q=21.206,P0.05;Z=-5.306,P=0.000;and q=19.370,P0.05,respectively）.Conclusions LC for acute cholecystitis is feasibly and safe with short operation time,less blood loss,reduced hospital stay,and low rate of conversion to open surgery.The optimal timing for the procedure is within 72 hours after onset.