急性胆囊炎腹腔镜切除术的手术时机对患者的影响

Effect of different operative time on conversion to open surgery,complications and inflammatory reaction in patients undergoing laparoscopic acute cholecystitis resection

目的探讨腹腔镜急性胆囊炎切除术(LC)的不同手术时间对患者中转开腹、并发症及炎症反应的影响。方法选取我院选取我院在2014年1月至2019年1月期间收治的102例急性胆囊炎患者(Grade分级:Ⅰ级~Ⅱ级),根据LC治疗时间(组1:48h内,n=34;组2:48~72h,n=33;组3:72h后,n=34)回顾性分析102例急性胆囊炎患者临床资料。比较2组围手术期临床指标,术前2h、术后4h、术后24h的IL-1、IL-10、TNF-α水平。分别计算术后4h上升百分比,术后24h上升百分比。结果组1患者的中转开腹比例高于组2及组3患者(P<0.05),组1患者术后并发症比例高于组1及组2患者(P<0.05);组1及组2患者的总住院时间低于组3患者(P<0.05),组1患者的总住院时间低于组2患者(P<0.05)。组1患者的IL-1术后4h上升百分比、术后24h上升百分比高于组2及组3患者(P<0.05),组1患者的IL-10术后4h上升百分比高于组2及组3患者(P<0.05),组1患者的TNF-α术后4h上升百分比高于组2及组3患者(P<0.05)。结论LC治疗急性胆囊炎的最佳时机依然有待进一步的证实。根据我们的研究,48~72h是LC治疗急性胆囊炎的最佳时机。

Objective To investigate the effect of laparoscopic acute cholecystitis resection(LC)on conversion to laparoto・my,complications and inflammation.Methods 102 patients with acute cholecystitis admitted to our hospital from January 2014 to January 2019(Grade classification:GradeⅠ~Ⅱ)were selected.The clinical data of 102 patients with acute cholecystitis were retrospectively analyzed according to the treatment time of LC(group 1:48 h,n=34;group 2:48~72 h,n=33;group 3:72 h,n=34).The levels of IL-1,IL-10 and TNF-alpha were compared between the two groups at 2 hours before operation,4 hours after operation and 24 hours after operation.The percentage of increase at 4 hours and 24 hours after operation were calculated respectively.Results The conversion rate of group 1 patients to open surgery was higher than that of group 2 and group 3 patients(P<0.05).the complication rate of group 1 patients was higher than that of group 1 and group 2 patients(P<0.05),the total hospitalization time of group 1 and group 2 patients was lower than that of group 3 patients(P<0.05),and the total hospitalization time of group 1 patients was lower than that of group 2 patients(P<0.05).The percentage of IL-1 increased 4 hours after operation and 24 hours after operation in group 1 was higher than that in group 2 and group 3(P<0.05).The percentage of IL-10 increased 4 hours after operation in group 1 was higher than that in group 2 and group 3(P<0.05).The percentage of TNF-alpha increased 4 hours after operation in group 1 was higher than that in group 2 and group 3(P<0.05).Conclusion The optimal timing of LC in the treatment of acute cholecystitis remains to be further confirmed.According to our study,48~72 hours is the best time for LC to treat acute cholecystitis.