腹腔镜胆囊切除术治疗“高危”胆囊结石93例

Treatment of gallstones in high-risk patients using laparoscopic cholecystectomy:Analysis of 93 cases

目的:探讨腹腔镜胆囊切除术在"高危"胆囊结石患者中的诊治体会.方法:对180例诊断为"高危"胆囊结石的患者进行临床分组观察,观察组治疗方案为腹腔镜胆囊切除术,对照组治疗方案为常规开腹胆囊切除术.分析两组患者手术时间、住院时间、术中出血等手术指标,同时根据美国麻醉医师学会(AⅡeIe-specific amplication,ASA)分级对观察组患者进行Ⅱ-Ⅳ级的分组观察,观察ASAⅡ、ASAⅢ以及ASAⅣ级患者在年龄、住院时间、并存病及并发症等方面的情况比较.结果:观察组患者手术时间、术中出血、住院时间等手术指标均低于对照组(78.0 min±15.6 minvs 91.9 min±14.4 min,59.3 mL±18.4 mLvs 76.1 mL±22.8 mL,4.03 d±1.02 dvs6.98 d±1.77 d,均P<0.01).ASAⅢ级以及ASAⅣ级患者出现并存系统患病例数和平均并存系统患病数以及并存疾病数和平均并存疾病数均明显高于ASAⅡ级患者.ASAⅡ级患者平均住院时间以及平均合并系统患病数、平均合并病数均明显少于ASAⅢ以及ASAⅣ级患者(11.5±5.7 vs 16.0±10.9,36.5±15.8;1.1±0.3vs 1.3±0.6,2.2±1.0;1.1±0.4vs 1.6±0.9,2.6±1.2,均P<0.05).结论:腔镜胆囊切除术与传统开腹胆囊切除术相比,疗效更优,包括减少手术时间、住院时间以及术中出血等.此外,ASA分级对患者预后有较大的影响,ASAⅡ级患者相关观察指标优于ASAⅢ级以及ASAⅣ级患者.通过加强手术期间的监护,能够有效降低患者其术后并发症的出现以及死亡.

AIM： To investigate the value of laparoscopic cholecystectomy （LC） in the treatment of gallstones in high-risk patients. METHODS： One hundred high-risk patients with gallstones were divided into either an observation group or a control group. The observation group underwent LC, while the control group received conventional open cholecystectomy （COC）. The operative time, length of hospital stay, intraoperative bleeding, comorbidities, and complications were compared between the two groups. The ASA classification system was used to classify the observation group into several subgroups （Ⅱ to Ⅳ） to compare the above parameters. RESULTS： The operative time, length of hospital stay, and intraoperative bleeding were significantly better in the observation group than in the control group （78.0 min ± 15.6 min vs 91.9 min ± 14.4 min, 59.3 mL ± 18. 4 mL vs 76.1 mL ± 22.8 mL, 4.03 d ± 1.02 d vs 6.98 d ± 1.77 d, all P 〈 0.01）. ASAⅢ and Ⅳ patients had significantly longer hospital stay and greater number of comorbidities and complications were significantly higher than ASA Ⅱ patients （11.5 ± 5.7 vs 16.0 ± 10.9, 36.5 ± 15.8; 1.1 ± 0.3 vs 1.3 ± 0.6, 2.2 ± 1.0; 1.1 ± 0.4 vs 1.6 ± 0.9, 2.6 ± 1.2, all P 〈 0.05）. CONCLUSION： LC is superior to COC in the management of gallstones in high-risk patients in terms of reducing operative time, length of stay and intraoperative bleeding. ASA has a significant impact on prognosis, and ASA Ⅱ patients have better prognosis than ASAⅢ and Ⅳ patients.