腹腔镜胆囊切除术治疗急性非结石性胆囊炎的临床分析

The clinical analysis of laparoscopic cholecystectomy for acute acalculous cholecystitis

目的：总结急性非结石性胆囊炎（acute acalculous cholecystitis,AAC）行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的治疗体会。方法：回顾分析22例AAC早期患者行LC的临床资料。结果：19例顺利完成腹腔镜手术,其中顺行切除胆囊13例,逆行切除胆囊6例;3例中转开腹。手术时间65~150 min,平均（85±15）min;术中出血量50~200 ml,平均（80±21）ml;术后住院3~5 d,平均（4.5±0.3）d。患者均无严重并发症发生,均痊愈出院。结论：AAC行LC是安全、可行的。AAC一旦诊断明确,应尽早施行LC,最佳手术时机为72 h内。手术操作谨慎、耐心、细致是保证手术成功的关键。操作困难及时中转开腹可有效避免严重并发症的发生。

Objective： To summarize the treatment experience of laparoscopic cholecystectomy（ LC） for acute acalculous cholecystitis（ AAC）. Methods： The clinical data of 22 patients with early AAC who underwent LC were retrospectively analyzed. Results：LC was successfully performed in 19 cases,of which 13 cases were anterograde cholecystectomy,6 cases were retrograde cholecystectomy,other 3 cases were converted to laparotomy. The operation time was 65-150 min,the mean time was（ 85 ± 15） min. The intraoperative blood loss was 50-200 ml,the mean was（ 80 ± 21） ml. The postoperative hospital stay was 3-5 d,the mean was（ 4. 5 ± 0. 3） d. No serious complications were found,all patients were cured and discharged. Conclusions： LC for AAC is safe and feasible. Once the diagnosis of AAC is definite,LC should be performed as soon as possible,the optimal timing of surgery is within 72 h. Cautious,patient and meticulous operation is the key to ensure the success of surgery. Timely conversion to laparotomy when confronted with intraoperative difficulties can effectively prevent the occurrence of serious complications.