不同腹腔镜手术时机对急性结石性胆囊炎患者临床疗效的评价分析

Evaluation and analysis of the therapeutic effect of different laparoscopic surgery in patients with acute calculus cholecystitis

目的观察不同手术时机腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床疗效。方法回顾性分析我院于2012年1月～2015年10月收治的急性结石性胆囊炎患者114例，依据手术时机（从发病至手术的时间间隔）的不同，将于发病后72小时内、（72小时-21天）内、21天后行腹腔镜胆囊切除术治疗者分别设为早期组（39例）、中期组（37例）、晚期组（38例），记录三组患者的手术时间、术中出血量、术后首次排气时间、中转开腹、住院总时间、术后住院时间、住院总花费、术后住院花费、术后并发症、术后疼痛程度（视觉模拟评分法）等情况并进行统计学分析。结果三组患者手术时间、术后首次排气时间接近（F=1．026，P〉0．05；F=1．449，P〉0．05）；三组患者术中出血量的差异显著（F=8．247，P〈0．05），其中，早期组患者的术中出血量少于中期组（t=9．578，P〈0．05）及晚期组（t=9．007，P〈0．05），中期组和晚期组患者术中出血量相近（t=2．077，P〉0．05）；三组患者术后第1、3、5天疼痛程度接近（F=1．558，P〉0．05；F=1．746，P〉0．05；F=1．119，P〉0．05）；三组患者术后住院花费、术后住院时间接近（F=1．157，P〉0．05；F=1．775，P〉0．05；F=1．125，P〉0．05）；三组患者住院总花费、住院总时间的差异显著（F=6．897，P〈0．05；F=7．594，P〈0．05），其中，早期组患者的住院总花费、住院总时间少于中期组（t=5．267，P〈0．05；t=6．547，P〈0．05）及晚期组（t=8．579，P〈0．05；t=10．238，P〈0．05），中期组患者的住院总花费、住院总时间少于晚期组（t=6．547，P〈0．05；t=7．564，P〈0．05）；入组114例患者中10例因出血难以控制中转开腹，其中，早期组患者中转开腹率2．56％，低于中期组的10．81％（X2=5．247，P〈0．05）及晚期组的13．16％（X2=7．259，P〈0．05），中期组和晚期组患者中转开腹率的差异无统计学意义（X2=2．014，P〉0．05）；早期组、中期组、晚期组患者肠瘘、腹腔感染、切口感染、腹腔积液、胆瘘的发生率分别为（2．63％、5．26％、7．89％、10．53％、10．53％）、（6．06％、12．12％、12．12％、12．12％、9．09％）、（6．06％、9．09％、12．12％、9．09％、9．09％），三组间患者各并发症发生率之间的差异均无统计学意义（X2=1．357，P〉0．05；X2=1．578，P〉0．05；X2=1．864，P〉0．05；X2=1．995，P〉0．05；X2=1．258，P〉0．05）。结论急性结石性胆囊炎发病72小时内行腹腔镜胆囊切除术具有失血少、中转开腹率低、住院时间短、花费少等优势，因此，尽早手术更趋合理。

Objective To observe the clinical effect of laparoscopic cholecystectomy in the treatment of acute gallstone chole- cystitis. Methods a retrospective review of 114 patients of acute cholecystitis in our hospital in January 2012 - 2015 year in October were based on the timing of surgery （from onset to operation time interval） is different, will be within 72 hours after onset, （72 hours 21 days） , 21 days after laparoscopic cholecystectomy treatment respectively. For the early group （39 cases） , medium group （37 ca- ses） and late group （38 cases） , bleeding operation time, three groups of patients with intraoperative and postoperative first exhaust time, laparotomy, total hospitalization time, postoperative hospitalization time and total cost of hospitalization cost, and postoperative postoperative complications, degree of pain （visual analogue scale）, and statistical analysis. Results close to the first exhaust time of three groups of patients with operation time, postoperative （F -- 1. 026, P 〉 0. 05 ; F = 1. 449, P 〉 0. 05 ） ; the difference amount of bleeding in the three groups was significant （ F = 8. 247, P 〈 0. 05） , among them, the group of patients with early bleeding is less than the middle group （ t = 9. 578, P 〈 0. 05） and late group （t = 9.007, P 〈 0. 05）, mid and late hemorrhage group group of patients who were similar （ t = 2. 077, P 〉 0. 05 ） ; the three groups of patients after first, 3, 5 days of pain （ F = 1. 558, P 〉 0. 05 ; close to F = 1. 746, P 〉 0. 05 ; F = 1.119, P 〉 0. 05 ） ; three groups of patients with postoperative hospitalization cost, postoperative hospitalization time （ F = 1. 157, close to P 〉 0. 05 ; F = 1. 775, P 〉 0. 05 ; F = 1. 125, P 〉 0. 05 ） ; the three groups were the difference of the total cost, total hospitalization time significantly （ F = 6. 897, P 〈 0. 05 ; F = 7. 594, P 〈 0. 05 ）, the early group of patients in hospital, to- tal cost of hospitalization Time is less than the medium group （ t = 5. 267, P 〈 0. 05 ; t = 6. 547, P 〈 0. 05） and late group （ t = 8. 579, P 〈 0. 05 ; t = 10. 238, P 〈 0. 05 ）, the middle group of patients in hospital total cost, total hospitalization time less than the late group （ t = 6. 547, P 〈 0. 05 ; t = 7. 564, P 〈 0. 05） ; 114 patients were enrolled in 10 eases because of uncontrolled bleeding laparotomy a- mong them, the early group, the conversion rate of 2. 56% , lower than the middle group （X2 = 5. 247 10.81% , P 〈 0.05 13.16% ） and late group （ X2 = 7. 259, P 〈 0. 05 ） , the mid and late groups were converted to laparotomy rate difference was not statistically sig- nificant （X2 = 2. 014, P 〉 0. 05 ） ; early group, middle group and advanced group patients with intestinal fistula, abdominal cavity in- fection, wound infection, abdominal effusion, biliary fistula incidence rate （ 2. 63% , 5.26% , 7.89% , 10. 53% , 10. 53% ） , （6. 06%, 12. 12%, 12. 12%, 12. 12%, 9. 09%, （6.06%） , 9. 09%, 12. 12% and 9. 09%, 9. 09% ）. Among the three groups of patients with the complication occurrence rate differences had no statistical significance （ X2 = 1. 357 （ P 〈 0. 05 ）. X2 =1. 578 （ P 〈 0. 05）. X2 = 1. 864 （P 〈0. 05）. X2 = 1. 995 （P 〈 0. 05）. X2 = 1. 258, P 〉 0. 05）. Conclusion laparoscopic cholecystectomy for acute cholecystitis in 72 hours with less blood loss, lower conversion laparotomy rate, shorter hospital stay, less cost and so on, therefore, the operation is more reasonable as soon as possible.