老年急性结石性胆囊炎发病>72 h行腹腔镜手术治疗的可行性及安全性研究

The feasibility and safety of laparoscopic surgery for onset of elderly acute calculous cholecystitis>72 h

目的探讨老年急性结石性胆囊炎(ACC)发病>72 h行腹腔镜手术治疗的可行性及安全性。方法回顾性分析2013年1月至2018年1月间行腹腔镜胆囊切除术(LC)的老年ACC患者106例临床资料,根据发病时间分为>72 h组(n=48)和≤72 h组(n=58)。>72 h组均于发病72 h后行LC,≤72 h组均于发病72 h内行LC。比较两组手术情况(手术时间、术中出血量、中转开腹率)、术后恢复进程(术后首次排气时间、术后住院时间、总住院时间),评估患者术后第1、3、5d疼痛视觉模拟评分(VAS),记录两组术后并发症发生率。结果两组中转开腹率和术后住院时间比较差异无统计学意义(P>0.05),>72 h组手术时间、首次排气时间、总住院时间均长于≤72 h组,术中出血量大于≤72 h组(P<0.05);两组术后第1、3、5d患者VAS得分均呈下降趋势(P<0.05),但两组各时间点比较差异无统计学意义(P>0.05);两组切口感染、肺部感染、胆汁瘘、低蛋白血症及总并发症发生率比较,差异均无统计学意义(P>0.05)。结论老年ACC患者发病>72 h行LC会增加其手术时间、术中出血量和术后排气时间,但不增加术后并发症风险及中转开腹率。

Objective To explore the feasibility and safety of laparoscopic surgery for onset of elderly acute calculous cholecystitis(ACC)>72 h.Methods The clinical data of 106 patients with elderly ACC who underwent laparoscopic cholecystectomy(LC)from January 2013 to January 2018 were retrospectively analyzed.According to the onset time,they were divided into>72 h group(n=48)and≤72 h group(n=58).The>72 h group was given LC after 72 h of onset,and≤72 h group was given LC within 72 h of onset.The operation indexes such as operative time,intraoperative blood loss,rate of conversion to open surgery and postoperative recovery process such as the first exhaust time,postoperative hospital stay and total hospital stay were compared between the two groups.The pain of visual analogue scale(VAS)was evaluated on the 1st,3rd and 5th day after operation.The incidence rate of postoperative complications was recorded.Results There were no significant differences in the rate of conversion to open surgery and postoperative hospital stay between the two groups(P>0.05).The operative time,the first exhaust time and total hospital stay in the>72 h group were longer than those in the≤72 h group.The intraoperative blood loss in the>72 h group was greater than that in the≤72 h group(P<0.05).The VAS scores on the 1st,3rd and 5th day showed a downward trend(P<0.05),and there was no significant difference between the two groups at each time point(P>0.05).There was no significant difference in the incidence rates of incision infection,pulmonary infection,bile fistula and hypoproteinemia as well as total incidence rate of complications between the two groups(P>0.05).Conclusion LC at onset of elderly ACC>72 h may increase the operative time,intraoperative blood loss and postoperative exhaust time,but it does not increase the risk of postoperative complications and the rate of conversion to open surgery.