急诊腹腔镜胆囊切除术192例临床分析

Clinical analysis of 192 cases of emergency laparoscopic cholecystectomy for acute cholecystitis

目的:探讨急诊腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎(acute cholecystitis,AC)的手术时机与临床效果。方法:回顾分析为192例AC患者行LC的临床资料,其中单纯性胆囊炎57例,化脓性胆囊炎115例,坏疽性胆囊炎20例,合并胆囊穿孔4例。发病至手术时间72 h内154例(A组),>72 h 38例(B组)。161例完整切除胆囊(C组),31例行部分切除术(D组)。结果:A、B两组患者手术时间、术后住院时间、中转开腹、放置引流管比例差异均有统计学意义,C、D两组仅放置引流管比例差异有统计学意义。均无胆管损伤、手术死亡等严重并发症发生。结论:对于急性胆囊炎,手术时机的把握是手术成功的关键。发病72 h内施术,操作简单易行、预后好。操作困难、手术难度较大的病例,过分追求完整切除胆囊可造成出血、损伤等并发症,部分切除术同样有效。

Objective： To explore the opportunity and curative effect of emergency laparoscopic cholecystectomy （LC） for acute cholecystitis （AC）. Methods：The clinical data of 192 patients with AC who were treated with emergency LC were collected and ana- lyzed retrospectively. Among these patients,57 cases had simple cholecystitis, 115 cases had acute suppurative cholecystitis and 20 ca- ses had acute gangrenous cholecystitis. 4 cases combined with perforation of gallbladder. In 154 cases （group A） emergency operation was performed within 72 h after the symptoms occurred and in 38 cases （ group B） operation was undertaken after 72 h. Gallbladders were resected completely in 161 patients （group C） and partially in 31 patients （group D）. Results：The data including operation time, post-operation hospital stay, ratio of conversion to open procedure, and cases of drainage in group A and group B showed significant differences. There was no difference except the cases of drainage between group C and group D. There were no severe complications such as bile duct injury or mortality. Conclusions：AC is not a contraindication for emergency LC. The key point of the successful surgery is seizing the operation opportunity. Within 72 h of onset,the operation is simple with good prognosis. As to the difficult cases, excessive pursuit of complete removal of the gallbladder might cause bleeding, damage and other complications, and partial resection is also effec- tive.