不同手术时机腹腔镜胆囊切除对老年急性胆囊炎患者术后疗效和康复的影响

The effect of different timing for laparoscopic cholecystectomy on the curative effect and rehabilitation of the elderly patients with acute cholecystitis

目的探究不同手术时机腹腔镜胆囊切除对老年急性胆囊炎患者术后疗效和康复的影响。方法采用回顾性分析法,选取2013年9月至2017年9月收治的行腹腔镜胆囊切除术的老年急性胆囊炎患者,将发病48h后实施手术的59例患者作为延期组,将发病48 h以内实施手术的59例患者作为早期组。采用SPSS19. 0进行数据统计分析,两组术中术后各项指标、CD3+、CD4+用(x珋±s)表示,行独立t检验;两组并发症发生率行χ2检验,P <0. 05为差异有统计学意义。结果早期组手术时间、术中出血量、肛门排气时间、住院时间均短于延期组(P <0. 05);早期组术后1 d、2 d、4d的CD3+、CD4+指标均高于延期组(P <0. 05);早期组穿孔、感染、坏疽、腹腔内出血、胆管损伤发生率均低于延期组,差异均有统计学意义(P <0. 05)。结论老年急性胆囊炎患者于病发后48 h内进行腹腔镜胆囊切除术,可有效促进机体康复,提高免疫能力,降低术后严重并发症发生率,值得推广。

Objective To explore the effect of different timing for laparoscopic cholecystectomy on the curative effect and rehabilitation of the elderly patients with acute cholecystitis. Methods Retrospective analysis was performed to select patients with acute cholecystitis who underwent laparoscopic cholecystectomy from September 2013 to September 2017.59 patients who underwent surgery 48 hours after the onset of surgery were treated as an extension group,and the disease was implemented within 48 hours after onset.59 patients underwent surgery as an early group.SPSS19.0 was used for statistical analysis.The indexes of postoperative operation,CD3^+and CD4^+were expressed as(x±s)in both groups,and the independent t test was performed.The complication rates of two groups were tested by χ^2 test,P<0.05 was considered as the difference There is statistical significance. Results The operation time,intraoperative blood loss,anal exhaust time and hospitalization time in the observation group were shorter than those in the control group(P<0.05).The CD3^+and CD4^+indexes of the observation group at 1,2 and 4 days after operation(P<0.05).The incidences of perforation,infection,gangrene,intraperitoneal hemorrhage and bile duct injury in the early group were lower than those in the delayed group,with statistical significance(P<0.05). Conclusions Laparoscopic cholecystectomy in elderly patients with acute cholecystitis within 48 hours after the onset of the disease can effectively promote the recovery of the body,enhance the immune capacity and reduce the incidence of postoperative serious complications,which is worthy of promotion.