不同手术时机和术式治疗老年急性化脓性胆囊炎的比较研究

Different Operation Timing and Operative Methods Comparative Research for the Treatment of Elderly Acute Suppurative Cholecystitis

目的:通过探讨不同手术时机和术式治疗老年急性化脓性胆囊炎的临床疗效,旨在为提高临床疗效和患者生活治疗提供理论依据。方法:选择2014年1月-2015年1月在本院接受治疗的老年急性化脓性胆囊炎患者180例,发病72 h内为研究A组,发病72 h后为研究B组,每组各90例患者,并根据患者实际情况选择开腹胆囊切除术、腹腔镜下胆囊切除术及超声引导下经皮经肝胆囊穿刺引流术,对比两组患者手术时间、术中出血量、住院时间,对比不同术式胃肠减压时间、术后排气时间、抗感染治疗时间、愈合时间,比较两组患者切口感染率、胆管损伤率、肺内感染率、胆漏率。结果:研究组A组患者手术时间为(45.52±2.71)min,术中出血量为(250.45±2.34)m L,住院时间为(11.04±1.10)d,均显著优于研究B组,比较差异有统计学意义(P<0.05);腹腔镜下胆囊切除术及超声引导下经皮经肝胆囊穿刺引流术在胃肠减压时间、术后排气时间、抗感染治疗时间、愈合时间均显著优于开腹术治疗。研究A组切口感染率为5.56%,胆管损伤率为7.78%,肺内感染率为4.44%,胆漏率为11.11%,均显著优于研究B组,比较差异均有统计学意义(P<0.05)。结论:老年急性化脓性胆囊炎在72 h内是手术的最佳时机,腹腔镜下胆囊切除术对于减少并发症、促进恢复有重要意义。

Objective：To explore the clinical efficacy of different surgical time and operation in the treatment of elderly patients with acute suppurative cholecystitis, and provide theoretical basis for improving the clinical efficacy and the life of patients.Method： 180 patients were selected from 2014 January to 2015 January in our hospital accepted treatment of elderly patients with acute suppurative cholecystitis, the incidence of 72 h of the A group, the incidence of B after 72 h group, 90 cases in each group, and patients were selected according to the actual circumstance of open cholecystectomy, laparoscopic cholecystectomy surgery and ultrasound guided percutaneous transhepatic gallbladder drainage operation was compared two groups with operation time, intraoperative blood loss, hospitalization time, contrast of different operative methods for gastrointestinal decompression time, postoperative exhaust time, anti-infection treatment time, healing time. To compare incision infection rate, bile duct injury rate, pulmonary infection rate, bile leakage rate between the two groups.Result： Study group A surgery time was （45.52±2.71） min, blood loss was （250.45±2.34） mL, hospitalization time was （11.04±1.10） d, which was significantly better than that of the study group B, and the difference was statistically significant （P〈0.05）. Laparoscopic cholecystectomy surgery and ultrasound guided percutaneous transhepatic gallbladder drainage operation at decompression time, postoperative exhaust time, anti-infective treatment time, healing time was significantly better than the laparotomy treatment. Study group A incision infection rate was 5.56%, bile duct injury rate was 7.78%, lung infection rate was 4.44%, pulmonary infection rate was 11.11%, which was significantly better than the study group B, and the difference was statistically significant （P〈0.05）.Conclusion：Elderly acute suppurative cholecystitis in 72h is the best time for surgery, laparoscopic cholecystectomy to reduce complications and promote the recovery is important.