急性胆囊炎腹腔镜手术837例临床分析

Clinical analysis of 837 cases of laparoscopic surgery for acute cholecystitis

目的探讨急性胆囊炎行腹腔镜胆囊切除术治疗的合理性及手术时机。方法回顾性分析因急性胆囊炎接受腹腔镜胆囊切除术(LC)治疗患者(LC组,n=837)和开腹胆囊切除术(OC)治疗患者(OC组,n=185)的临床资料。根据发病时间,将LC组患者再分为急性组(n=679,发病时间≤72 h)和亚急性组(n=158,发病时间>72 h)。对LC组与OC组、急性组与亚急性组患者的手术时间、术中出血量、术中中转开腹情况(中转率)、术后疼痛视觉模拟评分(VAS)和手术并发症的发生情况及住院时间等资料进行比较和分析。结果与OC组比较,LC组患者的手术时间和住院时间较短,术中出血量较少,VAS较低,两组间比较差异均有统计学意义(P<0.05);两组术后并发症发生率比较差异无统计学意义(P>0.05)。与亚急性组比较,急性组的手术时间和住院时间较短,术中出血量较少,中转率较低,两组间比较差异均有统计学意义(P<0.05)。结论对急性胆囊炎患者实施LC安全可行,发病72 h内手术成功率和安全性更高。

Objective To investigate the rationality and timing of laparoscopic cholecystectomy （LC） for acute cholecystitis. Methods The clinical data of 837 patients with acute cholecystitis undergoing LC （LC group） and 185 patients receiving open eholecysteetomy （OC） for acute cholecystitis （ OC group） were retrospectively analysed. According to the time of disease onset, patients in LC group were subdivided into acute group （tt = 679, time of disease onsets〈72 h） and subacute group （ n = 158, time of disease onset 〉 72 h） . The mean time of operation, volumes of bleeding during operation, rates of transference to open abdominal surgery, scores of visual analogue scale （VAS） after operation, prevalences of complications after operation and duration of hospitalization were compared between LC group and OC group and between acute group and subacute group. Results Compared with OC group, the time of operation and duration of hospitalization were shorter, the volume of bleeding during operation was smaller and VAS was lower in LC group, and there were significant differences in these parameters between two groups （P 〈 0. 05）. There was no significant difference in the prevalences of complications after operation between OC group and LC group （P 〉 0.05）. Compared with subacute group, the time of operation and duration of hospitalization were shorter, the volume of bleeding during operation was smaller and the rate of transference to open abdominal surgery was lower in acute group, and there were significant differences in these parameters between two groups （P 〈0.05）. Conclusion LC is feasible and safe for patients with acute eholecystitis, and surgical intervention within 72 h of disease onset may yield higher success rate and safety.