腹腔镜下胆囊切除术治疗急性结石性胆囊炎的最佳时机及中转开腹的影响因素

The best opportunity of laparoscopic cholecystectomy in acute calculous cholecystitis and the related factors of conversion to laparotomy

目的分析经腹腔镜下胆囊切除术对于急性结石性胆囊炎患者的最佳治疗时机并探讨其中转开腹的相关影响因素。方法随机选取我院行腹腔镜下胆囊切除术的急性结石性胆囊炎患者500例,按照手术时机将其分为四组。其中第一、二、三组患者的发作到手术时间分别为≤48、72 h与超过72 h,第四组患者则在对症治疗后实施手术,观察并比较四组患者的手术情况,分析影响患者中转开腹的相关因素。结果第三组患者的手术时间长于第一、二、四组患者(P<0.05);第一、四组患者的术中出血量与腹腔引流量显著低于第二、三组(P<0.05);第一组患者的并发症总发生率均低于第二、三、四组(P<0.05)。经Logistic回归分析,患者腹腔镜胆囊切除术中转开腹的独立高危因素包含手术时机>48 h及发生胆囊颈部结石嵌顿(P<0.05)。结论急性胆囊炎患者在发作后早期(发作后48 h内)开展腹腔镜胆囊切除术或在对症治疗后再实施手术,都能够降低患者手术风险和并发症发生率,而手术时机>48 h及发生胆囊颈部结石嵌顿都能够影响中转开腹,因此在临床治疗时需进行全面评估,以便于增加手术的成功率。

Objective To analyze the best opportunity of laparoscopic cholecystectomy in patients with acute calculuscholecystitis, and to investigate the related factors of conversion to laparotomy. Methods A total of 500 patients with acutecalculus cholecystitis undergoing laparoscopic cholecystectomy were randomly selected in our hospital from January 2010 toJanuary 2015. According to the surgical opportunity, they were divided into four groups. The time from onset to operation inthe first, second and third groups were ≤48, 72 h and more than 72h respectively, the patients of the fourth group receivedthe surgery after preoperative symptomatic treatment. The surgical condition were observed and compared in the four groups,the influencing factors of patients conversion to laparotomy were analyzed. Results The operation time in the third group waslonger than those in the first, second and fourth groups （P〈0.05）. The intraoperative blood loss and abdominal drainagevolume of the first and fourth groups were significantly lower than those of the second and third groups （P〈0.05）. The totalincidence of complications in the first group was lower than those of the second, third and fourth groups（P〈0.05）. Logisticregression analysis showed that the independent high -risk factors of patients undergoing laparoscopic cholecystectomyconverted to laparotomy including surgical opportunity 〉48 h and gallstone neck incarceration （P〈0.05）. ConclusionUndergoing laparoscopic cholecystectomy in the early post -onset period （within 48h after onset） or after symptomatictreatment in patients with acute calculus cholecystitis both can reduce the risk of surgery and the incidence of complications.Surgical opportunity 〉48h and gallstone neck incarceration can affect the conversion to laparotomy, the comprehensiveassessment should be carried out in the clinical treatment so as to increase the success rate of the operation.