基层医院开展无钛夹腹腔镜胆囊切除术治疗急性胆囊炎120例临床分析

Clinical analysis of non-titanium clip laparoscopic cholecystectomy in treating 120 cases of acute cholecystitis in basic medical unit

目的探讨无钛夹腹腔镜胆囊切除术治疗急性胆囊炎在基层医院的可行性、安全性和手术时机。方法将天津市武清区人民医院2010年12月至2012年12月120例急性胆囊炎行无钛夹腹腔镜胆囊切除术患者分为主动手术组(71例,发病72 h以内手术)、被动手术组(40例,发病72 h至1周手术)以及被迫手术组(9例,发病1周以上手术)的临床资料进行比较分析。结果 118例均顺利完成腹腔镜胆囊切除术,成功率为98.33%(118/120),2例中转开腹行胆囊大部切除术。主动手术组手术平均时间(53.10±4.98)min,术中出血(40.56±8.86)ml,无中转开腹及并发症发生,术后住院4 d。被动手术组手术平均时间(61.32±5.13)min,术中出血(110.34±21.77)ml,无中转开腹病例,并发剑突下切口感染2例,术后住院4～5 d。被迫手术组手术平均时间(107.45±10.76)min,其中2例发病时间超过1个月者中转开腹,术中出血(231.06±40.54)ml,并发剑突下切口感染2例。所有患者均临床治愈。120例术后随访3～6个月,无腹腔感染、胆管损伤、胆瘘等并发症,无胆总管残留结石。结论腹腔镜手术治疗急性胆囊炎在基层医院是一种安全、可行的治疗方法。用丝线腹腔镜下结扎的方法取代可吸收夹或钛夹,降低了医药费用,值得在基层医院推广。把握好手术时机非常关键,发病72 h以内手术效果最好,但在技术熟练、经验丰富的前提下,发病1周之内手术亦安全可行,但手术时间延长,出血增多,而超过1周则手术难度加大,手术时间延长,腹腔镜成功率降低。

Objective To investigate the feasibility,safety and operation time of non-titanium clip laparoscopic cholecystectomy in the treatment of acute cholecystitis in basic medical unit.Methods From December 2010 to December 2012,non-titanium clip laparoscopic surgery was performed for 120 cases of acute cholecystitis in the people’s hospital of Wuqing district.The clinical data of the patients were retrospectively reviewed.The patients were divided into three groups： The active operation group（71 patients,underwent operation within 72 hours）,the passive operation group（40 patients,underwent operation from 72 hours to one week） and the forced operation group（9 patients,underwent operation more than one week）.Results One hundred and eighteen cases had successful laparoscopic cholecystectomy,the success rate was 98.33%（118/120）,2 cases converted to laparotomy underwent subtotal cholecystectomy.In active operation group,the operation time was（53.10±4.98）min,intraoperative bleeding was（40.56±8.86）ml,no conversion to open surgery or complications,postoperative hospital stay was 4 days.In passive operation group,operation time was（61.32±5.13）min,intraoperative bleeding was（110.34±21.77）ml,no case converted to laparotomy,2 cases was complicated with subxiphoid incision infection,postoperative hospitalization days was 4-5 days.The operation time of forced operation group was（107.45±10.76）min,including 2 cases of onset time more than one month and converted to open surgery,intraoperative bleeding was（231.06±40.54）ml,2 cases complicated with subxiphoid incision infection.All patients were clinically cured.One hundred and twenty cases were followed up for 3 to 6 months,no abdominal infection,bile duct injury,biliary fistula or other complications,no residual stones in common bile duct.Conclusion Laparoscopic surgery is feasible,effective,and safe for acute pyogenic cholecystitis.With the method of laparoscopic ligation thread instead of absorbable clips or titanium clip,the medical cost was reduced,it is worth popularizing in primary hospitals.The operation effect was the best when operation timing critical within 72 hours of onset,but in the skilled,experienced promise,operation is safe and feasible within 1 week,but the operation time,bleeding increased,and the operation was more difficult when operation more than on week,operation time was longer,laparoscopic successful rate was lowered.