急性结石性胆囊炎行急诊与延期腹腔镜胆囊切除术的疗效分析(附74例报告)

The curative effect analysis between emergency and deferred laparoscopic cholecystectomy in treatment of 74 patients with acute calculous cholecystitis

目的:探讨急性结石性胆囊炎急诊行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的利弊。方法:回顾分析2015年3月至2016年3月为74例急性结石性胆囊炎患者行LC的临床资料。根据手术时机分为急诊组(<12 h,n=37)与延期组(12 h～1周,n=37)。结果:66例成功施行LC,8例中转开腹。急诊组术后发生肺部感染2例、切口感染1例,其中1例肺心病患者术后肺部感染较重,住院时间长,费用较高。延期组术后肺部感染1例、切口感染1例。两组患者术后并发症发生率差异无统计学意义(P>0.05)。急诊组术前住院时间、术前费用、腹腔粘连、中转开腹、术中出血量、手术时间、总住院时间及住院总费用均少于延期组(P<0.05)。结论:急性结石性胆囊炎行急诊LC虽然可降低费用,缩短住院时间、手术时间,减少术中出血量,但手术风险较大。可选一般情况较好、不能耐受急性胆囊炎症状、急诊手术愿望强烈的患者酌情行急诊LC。

Objective： To explore the pros and cons between emergency laparoscopic cholecystectomy and deferred laparoscopic cholecystectomy in treatment of acute calculous cholecystitis. Methods： The clinical data of 74 patients with acute calculous cholecystitis who received laparoscopic cholecystectomy in the third ward of hepatobiliary pancreatic surgery,the second affiliated hospital of Kunming medical university from Mar. 2015 to Mar. 2016 were retrospectively analyzed. According to the operation time,74 patients were divided into the emergency group （ 〈12 h,n = 37） and the deferred group （12 h to 1 week,n = 37）. Results： Sixty-six patients were performed laparoscopic cholecystectomy successfully,8 patients were converted to laparotomy. In the emergency group,there were 2 cases with postoperative pulmonary infection and 1 case with incision infection,one patient with cor pulmonale had longer hospitalization time and higher cost because of postoperative severe pulmonary infection. In the deferred group,there were 1 case with postoperative pulmonary infection and 1 case with incision infection. No statistically significant difference was found in postoperative complication rate between the two groups （P 〉 0. 05）. Preoperative hospitalization time,preoperative cost,abdominal adhesions,conversion to laparotomy rate,intraoperative blood loss,operation time,the total hospitalization time and total cost were all less in the emergency group than those in the deferred group （P〈 0. 05）. Conclusions： Though the cost,hospitalization time,operation time,intraoperative blood loss and conversion to laparotomy rate in the emergency laparoscopic cholecystectomy are all less than those in the deferred laparoscopic cholecystectomy,the risk is higher. If general situation of patient is good,patients can＇t tolerate the symptoms of acute cholecystitis and desire of emergency surgery is strong,emergency laparoscopic cholecystectomy can be recommended for them.