LC术治疗急性结石嵌顿性胆囊炎160例报告

Laparoscopic Cholecystectomy for Acute Calculous Incarcerated Cholecystitis:a Report of 160 Cases

目的探讨急诊腹腔镜胆囊切除术（LC）治疗急性结石嵌顿性胆囊炎的效果和手术时机的选择。方法回顾性分析160例胆囊颈部结石嵌顿所致急性胆囊炎患者行LC的临床资料,按发病到手术时间将其分为〈48h组（n=68）、48~72h组（n=33）和〉72h组（n=59）。比较3组患者的手术时间、术中出血、术后住院时间、术后并发症。结果 3组患者均无胆管损伤、无手术死亡、无中转病例;〈48h组均顺利完成手术,48~72h组1例、〉72h组2例行胆囊大部切除。〈48h组手术时间、术中出血量、住院时间均明显低于48~72h组、〉72h组（P〈0.05）。〈48h组穿刺口感染率明显低于48~72h组、〉72h组（P〈0.05）。3组术后胆漏发生率比较差异无统计学意义（P〉0.05）。结论急性结石嵌顿性胆囊炎一旦诊断明确,无手术禁忌证者,应尽可能在发病48h以内行LC术。这样可以尽早缓解患者痛苦,降低手术难度,还能缩短手术和住院时间,减少手术并发症。

Objective To investigate the effect of laparoscopic cholecystectomy（LC）on acute calculous incarcerated cholecystitis（ACIC）and the choice of operating timing.Methods Clinical data of 160 patients who underwent LC for acute cholecystitis induced by gallstones incarcerated in the neck of gallbladder were analyzed retrospectively.According to the time from onset to operation,these patients were divided into three groups：〈48h group（n=68）,48-72hgroup（n=33）and〉72h group（n=59）.The operation time,intraoperative bleeding,postoperative hospital stay and postoperative complications were compared among the three groups.Results No bile duct injury and death occurred in all patients.No patients were converted to open surgery.Patients in 〈48h group successfully completed the operation.One patient in 48-72 hgroup and two patients in 〉72h group underwent subtotal cholecystectomy.Compared with 48-72 hgroup and 72h group,the operation time,intraoperative bleeding,postoperative hospital stay and incidence of puncture infection significantly decreased in 〈48h group（P〈0.05）.There were no significant differences in the incidence of bile leakage among the three groups（P〉0.05）.Conclusion Once ACIC is confirmed,LC should be performed within 48 hours after onset as far as possible in patients with no contraindications to operation.The timely operation can alleviate the suffering of patients,reduce the difficulty of operation,shorten the operation time and hospital stay,and decreased the surgical complications.