急性胆囊炎最佳腹腔镜手术时机选择及影响因素分析

Optimal timing and influencing factors of laparoscopic cholecystectomy for acute cholecystitis

目的探讨腹腔镜手术治疗急性胆囊炎的最佳手术时机,分析影响腹腔镜手术转开腹的原因.方法纳入2014年1月至2018年7月太原市第八人民医院普外科收治的行腹腔镜胆囊切除术患者82例的临床资料,根据起病至手术时间将患者分为四组,A组(21例)起病至手术时间为48 h以内,B组(26例)起病至手术时间48~72 h,C组(19例)起病至手术时间>72 h至1周,D组(16例)起病至手术时间>1周.对比各组手术时间、术中出血量、转开腹比例、并发症发生率,分析影响转开腹的危险因素.结果A组、B组、C组、D组患者转开腹率分别为4.76%(1/21)、19.23%(5/26)、26.32%(5/19)、18.75%(3/16),C组转开腹率最高,A组最低,C组、A组与其他组差异均有统计学意义(χ^2=3.635、4.181、3.682、3.552、3.448,均P<0.05).单因素分析显示,转开腹与患者胆囊是否肿大、胆囊壁厚度、手术时机有关(均P<0.05).多因素分析显示,胆囊壁厚度≥6 mm[OR=1.310(95%CI:0.681~1.264),P=0.001]、手术时机(>48 h)[OR=2.672(95%CI:0.261~0.961),P=0.000]是急性胆囊炎腹腔镜术中转开腹的独立危险因素.结论急性胆囊炎起病48 h内进行腹腔镜手术可降低术中转开腹风险,胆囊壁厚度和手术时机是影响转开腹的独立危险因素.

Objective To explore the best operative time of laparoscopic cholecystectomy for acute cholecystitis,and analyze the causes of laparotomy.Methods The clinical data of 82 cases of laparoscopic cholecystectomy in the Department of General Surgery,the Eighth People's Hospital of Taiyuan from January 2014 to July 2018 were retrospectively analyzed.According to the onset to operation time,the patients were divided into four groups:group A(21 cases,the onset to surgery time was within 48 h),group B(26 cases,the onset to surgery time was 48-72 h),group C(19 cases,the onset to surgery time was>72 h-1 week),group D(16 cases,the onset to surgery time was more than 1 week).The operative time,intraoperative blood loss,conversion of abdominal cavity and complication rate were compared,and the risk factors of conversion to laparotomy were analyzed.Results The open abdominal rates of group A-D were 4.76%(1/21),19.23%(5/26),26.32%(5/19)and 18.75%(3/16),respectively.The rate of open abdomen in group C was the highest,which of group A was the lowest.There were statistically significant differences between group A and the other three groups(χ^2=3.635,4.181,3.682,3.552,3.448,all P<0.05).Single factor analysis showed that the laparotomy was related to the enlargement of the gallbladder,the thickness of the gallbladder,and the time of operation(all P<0.05).The analysis of multiple factors showed that the thickness of the gallbladder wall more than 6 mm[OR=1.310(95%CI:0.681-1.264),P=0.001],the time of operation more than 48 h[OR=2.672(95%CI:0.261-0.961),and P=0.000]were independent risk factors for transabdominal surgery of acute cholecystitis laparoscopy.Conclusion Laparoscopic surgery within 48 hours of acute cholecystitis can reduce the risk of transabdominal surgery.The thickness of the gallbladder and the timing of the operation are independent risk factors affecting the transabdominal operation.