腹腔镜胆囊切除术治疗急性胆囊炎的疗效观察

The efficacy of laparoscopic cholecystectomy versus that of conventional open cholecystectomy for acute cholecystifis

目的探讨腹腔镜胆囊切除术（LC）治疗急性胆囊炎的疗效。方法回顾性分析我院收治的186例腹腔镜胆囊切除术患者（Lc组）和287例传统开放性手术患者（OC组）的临床资料，比较两组患者住院时间、手术时间、术中出血量、术后下床时间、术后排气时问、置引流管、腹腔引流量、手术前后CRP和PA水平变化。结果Lc组相比OC组住院时间、手术时间、术中出血量、术后排气时间均较明显缩短或减少，差异有统计学意义（P〈0．05）；两组患者在放置引流管例数、腹腔引流量无差异（P〉0．05）；手术后两组CRP水平均高于手术前，差异有统计学意义（P〈0．05），但OC组CRP水平明显高于LC组，差异有统计学意义（P〈0．01）；而术后PA两组均较术前降低，差异有统计学意义（P〈0．05），但OC组降低更为明显，差异有统计学意义（P〈0．01）.结论腹腔镜治疗急性结石性胆囊炎是对机体损伤小，可显著减轻患者痛苦，节约医疗资源，是一种可行、安全且有效的治疗方法。

Objective To investigate the efficacy of laparoscopic cholecystectomy （ LC ） for acute cholecystitis. Methods The clinical data on 186 patients undergoing LC and 287 patients under- going open cholecystectomy （ OC ） were retrospectively analyzed and the patients were divided into LC group and OC group. Length of hospital stay, surgical duration, intraoperative bleeding volume, time to ambulation after surgery, time to anal exhaust, rate of placing drainage tube, drainage amount of abdominal cavity, rate of incisional infection, and changes in levels of CRP and PA were compared between the two groups. Results Length of hospital stay, surgical duration, and time to anal exhaust were significantly shorter and intraoperative bleeding volume was smaller in LC group than in OC group （ P〈 0.05 ）. There were no significant differences in the rate of placing drainage tube and in drainage amount of abdominal cavity between LC group and OC group （ P〉 0.05 ）. CRP level was obviously higher in OC group than in LC group （ P 〈 0.01 ）; whereas PA level significantly declined in both groups as compared with the baseline （ P 〈 0.05 ）, more markedly in OC group （ P 〈 0.01 ）. Conclusions Laparoscopic cholecystectomy for acute cholecystitis is less invasive and can evidently relieve pain in patients and save medical resources. It is a feasible, safe, effective surgical procedure.