腹腔镜胆囊切除治疗合并糖尿病的急性化脓性胆囊炎96例分析

Laparoscopic cholecystectomy for acute suppurative cholecystitis with diabetes: an analysis of 96 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性化脓性胆囊炎合并糖尿病患者的手术时机、可行性及安全性。方法:回顾分析2012年2月至2015年4月为96例合并糖尿病的急性化脓性胆囊炎患者行LC的临床资料。结果:88例于72 h内成功施行LC,1例因合并严重哮喘,经控制血糖、保守治疗1周后行LC;2例行B超引导下经皮、经肝胆囊穿刺引流72 h后行LC;2例行胆囊大部切除术;3例因胆囊包裹、粘连致密、解剖不清,其中1例合并肝脓肿而中转开腹。手术时间平均(80±25)min,术中出血量平均(90±20)ml。术后切口感染1例,经保守治疗痊愈;肝脓肿形成1例,经皮肝穿刺引流后治愈。平均住院(9±4)d。结论:积极控制血糖、掌握合适的手术时机后行LC,治疗合并糖尿病的急性化脓性胆囊炎是安全、可行的。

Objective： To investigate the operative timing,feasibility and safety of laparoscopic cholecystectomy（ LC） for acute suppurative cholecystitis with diabetes. Methods： Retrospective analysis was made on the clinical data of 96 patients who suffered from diabetes mellitus combined with acute suppurative cholecystitis and underwent LC from Feb. 2012 to Apr. 2015. Results： LC within 72 h was successfully performed for 88 patients,1 patient with severe asthma underwent the control of blood sugar,conservative treatment for one week and LC. 2 patients underwent ultrasound guided percutaneous transhepatic drainage and LC after 72 h. 2 patients received resection of the most gallbladder. 3 cases were converted to laparotomy because of gallbladder parcel,dense adhesion,unclear anatomy,and among them 1 case combined liver abscess. Operative time was（ 80 ± 25） min,the blood loss was（ 90 ± 20） ml. 1 case with postoperative incision infection was cured by conservative treatment. 1 case with liver abscess was cured by percutaneous transhepatic puncture and drainage. The hospital stay was（ 9 ± 4） d. Conclusions： When positive control of the blood sugar and sufficient supervision of the suitable operative timing are offered,LC is safe and feasible in the treatment of acute suppurative cholecystitis with diabetes.