结石性胆囊炎行腹腔镜胆囊切除术的时机选择

The opportunity selection of performing laparoscopic cholecystectomy for calculous cholecystitis

目的:探讨不同临床表现的结石性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)最佳治疗时机的选择。方法:回顾分析2010年2月至2014年2月600例结石性胆囊炎患者的临床资料,按照患者症状、体征进行分组,Ⅰ组345例,肌注杜冷丁、山莨菪碱,腹痛不缓解,出现局限性腹膜炎体征;Ⅱ组228例,腹痛明显,肌注杜冷丁、山莨菪碱,腹痛可缓解,无腹膜炎体征;Ⅲ组27例,腹痛合并黄疸。结果:Ⅲ组中转开腹率、术后并发症发生率高于Ⅰ组、Ⅱ组,手术时间长于Ⅱ组。结论:72 h内是最佳的手术时机,但也应综合考虑患者发病时间、症状与体征,以选择最佳的手术时机,指导临床,降低中转开腹率及术后并发症发生率。

Objective： To investigate the best opportunity to perform laparoscopic cholecystectomy for patients with calculous cholecystitis. Methods： Clinical data of 600 patients with calculous cholecystitis from Feb. 2010 to Feb. 2014 were retrospectively analyzed. Patients were divided into three groups according to different symptoms and signs. 345 cases in Group Ⅰ showed signs of local peritonitis without relief after pethidine and anisodamine treatment. 228 cases in Group Ⅱ suffered from severe abdominal pain and could relieved after pethidine and anisodamine injection,signs of peritonitis were not observed. Group Ⅲ contained 27 cases,all of which were observed with jaundice and abdominal pain. Results： The rate of conversion to laparotomy and postoperative complications in Group Ⅲ were higher than those in GroupⅠ and Ⅱ,operation time of Group Ⅲ was longer than that of Group Ⅱ. Conclusions： Surgeries had better be performed within 72 h. Disease onset time,symptoms and signs should be taken into considerations,in order to select the best surgery opportunity and decrease conversion rates and complications.