早期腹腔镜胆囊切除术治疗急性结石性胆囊炎的回顾性研究

A retrospective study of early laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis

目的对早期腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床疗效进行回顾性分析。方法选取2017年1月至2018年8月泾县医院接受手术治疗的32例急性结石性胆囊炎病人作为研究对象,按照从症状发作到接受腹腔镜胆囊切除术的时间间隔分为两组,早期手术组(18例)为症状发作72 h内手术的病人,延期手术组(14例)为症状发作后超过72 h手术的病人;对比分析围手术指标、中转开腹例数及并发症发生情况的组间差异性。结果在术中出血量、手术时间、术后肛门排气时间及住院时间方面,早期手术组均明显低于延期手术组(t=2.134,P=0.041;t=2.303,P=0.028;t=3.863,P=0.001;t=2.618,P=0.014);早期手术组的中转开腹率为0.00%,明显低于延期手术组的28.57%(χ~2=5.877,P=0.015);在并发症发生率方面,早期手术组为5.56%,低于延期手术组的14.29%,但差异无统计学意义(P=0.568)。结论在急性结石性胆囊炎的治疗中,早期腹腔镜胆囊切除术安全可靠性高,可有效改善病人的临床症状,中转开腹率和术后并发症发生率也得到有效降低,具有较好的临床推广应用价值。

Objective To retrospectively analyze the clinical efficacy of early laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis.Methods Thirty-two patients with acute calculous cholecystitis who underwent surgery in Jingxian Hospital from January 2017 to August 2018 were enrolled in the study.They were assigned into two groups according to the time interval from symptom onset to laparoscopic cholecystectomy.Patients of the early operation group(18 cases)were operated within 72 hours after symptom onset,while patients of the delayed operation group(14 cases)were operated more than 72 hours after symptom onset.The differences in perioperative indexes,number of cases of conversion to open surgery,and status of complications were compared between two groups.Results The amount of bleeding,operation time,postoperative anal exhaust time and hospitalization time in early operation group were significantly lower than those in delayed operation group(t=2.134,P=0.041;t=2.303,P=0.028;t=3.863,P=0.001;t=2.618,P=0.014,respectively).The rate of conversion to laparotomy in the early surgery group was 0.00%,which was significantly lower than 28.57%in the delayed surgery group(χ^2=5.877,P=0.015).The complication rate of the early operation group was 5.56%,which was lower than 14.29%of the delayed surgery group,but the difference was not statistically significant(P=0.568).Conclusion In the treatment of acute calculous cholecystitis,early laparoscopic cholecystectomy is safe and reliable,which can effectively improve the clinical symptoms of patients,and reduce the conversion rate to laparotomy and the incidence of postoperative complications,thus having better value of clinical application.