胆囊结石伴急性胆囊炎患者行腹腔镜手术时机的选择分析

Analysis of the Timing of Laparoscopic Surgery in Patients with Cholecystolithiasis And Acute Cholecystitis

目的通过对胆囊结石伴急性胆囊炎患者选用不同时机进行腹腔镜手术,观察其临床效果,探究不同时机腹腔镜手术的临床效果特点的差异性。方法从来该院诊治的2015年1月—2018年10月的胆囊结石合并急性胆囊炎患者中随机抽取81例,采用随机数字法随机分为对照组41例:入院后立即进行腹腔镜胆囊切除术;观察组40例:3~5 d的解痉、补液以及抗炎治疗,再实施腹腔镜胆囊切除术。比较两组患者的引流量、手术时间、出血量情况以及并发症情况。结果观察组引流量为(40.33±10.21)mL低于对照组(t=11.231,P<0.05),手术时间为(66.79±12.41)min低于对照组(t=12.632,P<0.05),出血量为(55.87±11.34)mL低于对照组(t=10.842,P<0.05);观察组并发症发生率(7.50%)低于对照组(14.63%)(χ^2=11.834,P<0.05),中转开腹率(5.00%)低于对照组(12.20%)(χ^2=10.321,P<0.05)。结论胆囊结石伴急性胆囊炎患者入院后先进行药物治疗,再实施腹腔镜胆囊切除术可有效降低引流量、手术时间、出血量,改善中专开腹和并发症的发生,是一项值得广泛应用的治疗方案。

Objective To observe the clinical effect of laparoscopic cholecystolithiasis with acute cholecystitis at different time,and to explore the difference of clinical effect characteristics of laparoscopic cholecystolithiasis at different time.Methods A total of 81 cases of cholecystolithiasis complicated with acute cholecystitis were randomly selected from January 2015 to October 2018 in our hospital and divided into control group(41 cases)with laparoscopic cholecystectomy immediately after admission and observation group(40 cases)with three to five days of spasmolysis,fluid replacement and anti-inflammatory treatment followed by laparoscopic cholecystectomy.The drainage volume,operation time,hospitalization time,bleeding volume and complications were compared between the two groups.Results The drainage volume was(40.33±10.21)mL in the observation group,which was lower than that in the control group(t=11.231,P<0.05).The operation time was(66.79±12.41)min,which was lower than that in the control group(t=12.632,P<0.05).The bleeding volume was(55.87±11.34)mL,which was lower than that in the control group(t=10.842,P<0.05).The incidence of complications in the observation group(7.50%)was lower than that in the control group(14.63%)(χ^2=11.834,P<0.05).The conversion rate to open surgery(5.00%)was lower than that of the control group(12.20%)(χ^2=10.321,P<0.05).Conclusion Laparoscopic cholecystectomy can effectively reduce drainage,operation time,bleeding volume,improve the rate of laparotomy and the incidence of complications of patients with gallstones and acute cholecystitis after admission.It is a treatment program worthy of wide application.