腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机探讨

目的：探究分析腹腔镜胆囊切除术治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素。方法回顾分析2014年12月至2015年12月收治的150例急性结石性胆囊炎患者为观察对象，根据患者接受手术的时间不同将其分为A组（手术时间48h内）、B组（手术时间48~72h）、C组（手术时间〉72h）。所有患者均采用腹腔镜胆囊切除术治疗，观察各组患者术后并发症及中转开腹情况。结果 A组、B组、C组的并发症发生率分别为8.00%、9.33%、12.00%，各组间比较差异均无统计学意义（P〉0.05）；A组患者的手术时间、术中出血量及住院时间等显著优于B组和C组，A组、B组、C组中转开腹率分别为2.00%、9.33%、20.00%，各组比较差异均具有统计学意义（P〈0.05）。结论急性结石性胆囊炎确诊后的48h是最佳手术时机，应及时采取相应手术治疗措施，其中肝功能异常、手术时机、胆囊肿大及白细胞计数是影响中转开腹的独立危险因素，临床诊断中应予以重视。

ObjectiveTo explore the affecting factors of optimal timing of surgery and conversion for laparotomy of laparoscopic cholecystectomy for acute cholecystitis .Methods Retrospective analysis were performed on the 150 cases of acute cholecystitis patients ,from December 2014 to December2015,according to the different time the patients will be divided into group A（surgery performed within 48h after onset）,B group （surgery performed between 48h to 72h after onset）,group C（surgery performed after 72h after onset）. All patients were treated with laparoscopic cholecystectomy treatment,observation of complications and laparotomy in patients after operation.ResultsIn the A group,B group,C group, the complication rate was 8%,9.33%,12%,no statistical significance of difference were found between groups the（P〉0.05）;for operation time, blood loss and hospitalization time ,A group of patients were significantly better than those of B group and C group,laparotomy rate were 2%,9.33%, 20% in A group,B group and C group, with statistically significant differences（P〈0.05）.Conclusions 48h after the acute calculus cholecystitis was diagnosed is the optimal timing of surgery, timely and appropriate surgical treatment should be taken,abnormal liver function,operation time, gallbladder enlargement and white cell count are independent risk factors of influence of conversion to open surgery, which is of high value and should be paid attention to in clinical practice.