急性结石性胆囊炎80例手术治疗的临床效果观察

Observation on clinical effect of 80 cases of acute calculous cholecystitis treated with operation

目的对80例急性结石性胆囊炎患者的临床手术治疗情况和结果进行比较观察。方法 80例行手术治疗的急性结石性胆囊炎(无合并肝内外结石)患者,根据抽签法将其随机分为对照组(实施直接胆囊切除手术)及观察组(实施B超引导下胆囊造瘘术后隔月行胆囊切除术),各40例。对比两组患者的手术时间、术中出血量、症状缓解时间、胃肠功能恢复时间、视觉模拟评分法(VAS)评分、并发症情况及临床疗效。结果观察组患者的手术时间、术中出血量、症状缓解时间、胃肠功能恢复时间、VAS评分均优于对照组,差异均具有统计学意义(t=15.72673、18.92455、7.14859、8.96481、24.46145,P<0.05)。观察组并发症发生率为10.00%,低于对照组的37.50%,差异具有统计学意义(χ~2=8.35203,P<0.05)。观察组有效率97.50%高于对照组80.00%,差异具有统计学意义(χ~2=6.13459,P<0.05)。结论急性结石性胆囊炎通过胆囊造瘘术后隔月行胆囊切除术治疗,其在手术出血量、症状缓解、并发症以及治疗效果方面均明显优于直接胆囊切除术,值得推广。

Objective To compare and observe the clinical surgical treatment and outcome of 80 cases of acute calculous cholecystitis patients. Methods A total of 80 acute calculous cholecystitis patients（uncomplicated with intra-and extrahepatic stones）treated with operation were divided by lottery method into control group（received direct cholecystectomy） and observation group（received B-mode ultrasonography guided cholecystostomy and cholecystectomy every other month）, with 40 cases in each group. Comparison were made on operation time, intraoperative bleeding volume, symptoms relief time, gastrointestinal function recovery time, visual analogue scale（VAS） score, complications and clinical curative effect in two groups. Results The observation group had better operation time, intraoperative bleeding volume, symptoms relief time, gastrointestinal function recovery time and VAS score than the control group, and the difference had statistical significance（t=15.72673, 18.92455, 7.14859, 8.96481, 24.46145, P0.05）. The observation group had lower incidence of complications as 10.00% than 37.50% in the control group, and the difference had statistical significance（χ~2=8.35203, P0.05）. The observation group had higher effective rate as 97.50% than 80.00% in the control group, and the difference had statistical significance（χ~2=6.13459, P0.05）. Conclusion Cholecystectomy every other month after cholecystostomy shows better effect in operation bleeding volume, symptom relief, complications and treatment effect than direct cholecystectomy, and it is worth promotion.