门诊腹腔镜胆囊切除术的可行性探讨

Investigation of the feasibility of out-patient laparoscopic cholecystectomy

目的探讨门诊与住院腹腔镜胆囊切除术的临床效果,为临床腹腔镜胆囊切除术的多种选择提供理论依据。方法选择符合腹腔镜胆囊切除术指征的60例患者,按随机数字表法分为两组各30例,研究组实施门诊腹腔镜胆囊切除术(OPLC),对照组实施住院腹腔镜胆囊切除术(IPLC),比较两组患者手术时间、术中出血量、术后通气时间、住院时间、手术成功率、住院费用及术后并发症发生情况,并调查两组患者对治疗的满意度。结果研究组在手术时间、术中出血量、术后通气时间、手术成功率等方面与对照组比较差异无统计学意义(P>0.05);而研究组的住院时间及总治疗费用分别为(29.1±7.2)h和(6578.3±420.1)元,明显低于对照组的(59.3±14.5)h和(7689.4±560.3)元,两组比较差异有统计学意义(P<0.01);研究组及对照组患者对治疗满意度分别为96.7%及93.3%,比较差异无统计学意义(P>0.05);研究组及对照组并发症发生率分别为13.3%及16.7%,比较差异无统计学意义(P>0.05)。结论门诊腹腔镜胆囊切除术较住院腹腔镜胆囊切除术可明显缩短住院时间,减少医疗费用,且安全性高,能提高床位周转率,有效改善住院难等问题,值得临床推广应用。

Objective To investigate the clinical effect of outpatient and inpatient laparoscopic choleeysteetomy, so as to provide theoretical basis for multiple choices of laparoscopic cholecystectomy in clinic.Methods 60 patients having indications for laparoscopic cholecystectomy in our hospital were randomly divided into study group and control group with 30 cases in each group according to random table method.The study group underwent outpatient laparoscopic eholecystectomy（ OPLC ）, while the control group underwent inpatient laparoscopie cholecystectomy（IPLC） .The operation time ,intraoperative bleeding volume, postoperative ventilation time, length of stay, operation success rate, cost of hospitalization and postoperative complica- tions of two groups were compared, and the satisfaction degree of two groups were also investigated.Results The operation time, intraoperative bleeding volume, postoperative ventilation time, operation success rate of the study group were not signifi- cantly different from those of the control group（ P〉0. 05）.The hospitalization time and the total cost of treatment of the study group were （ 29.1 ＋7.2） h and （ 6578.3＋420.1 ） yuan, significantly lower than those （ 59.3＋ 14.5） h and （7689.4＋560.3） yuan of the control group, so there was statistically significant difference between two groups in these indexes （P〈0. 01 ）.The treat- ment satisfaction of the study group and the control group were 96.7% and 93.3% respectively, so no significant statistical difference was found between two groups（P〉0.05）.The incidence of complications of the study group and the control group were 13.3% and 16.7% respectively, and the difference was not statistically significant（ P〉0. 05 ）.Conclusion Compared with IPLC, OPLC can significantly shorten the hospital stay and lower medical cost. It has a high safety, and can effectively solve difficult problems such as having difficulties to be hospitalized ,etc.Thus ,it is worthy of clinical application.