合并黄疸的急性胆囊炎急诊行腹腔镜胆囊切除术安全性分析

Safety analysis of emergency laparoscopic cholecystectomy for acute cholecystitis with jaundice

目的:探讨合并胆红素升高的急性胆囊炎患者急诊行腹腔镜胆囊切除术的安全性。方法:选取2016年11月—2018年11月期间急性胆囊炎急诊行腹腔镜胆囊切除的患者195例,其中术前合并黄疸患者37例,无黄疸患者158例,比较两组患者术中出血量、术后住院时间、中转开腹率、术后并发症发生率、并发症综合指数和Clavien-Dindo分级标准。结果:合并黄疸组和不合并黄疸组患者的一般临床资料差异无统计学意义(P>0.05),合并黄疸组和不合并黄疸组患者在术中出血量[(24.5±12.4) vs.(18.9±15.7) mL]、术后住院时间[(5.8±3.3) vs.(6.9±3.1) d]、中转开腹率(5.4%vs.5.7%)、术后并发症发生率(8.1%vs.11.4%)、并发症综合指数[(5.2±9.8) vs.(8.0±6.1)分]和Clavien Dindo分级超过Ⅱ级比例(2.7%vs.1.3%)方面差异无统计学意义(P>0.05)。结论:合并黄疸的急性胆囊炎患者若在术前检查提示无明确胆道结石或肿瘤引起的胆总管梗阻的情况下,急诊行腹腔镜胆囊切除术是安全、可行的。

Objective: To explore the safety of laparoscopic cholecystectomy(LC) in patients with jaundice. Methods: A total 195 patients with acute cholecystitis who underwent emergency LC from November 2016 to November 2018 were selected. Among them, 37 cases were preoperatively complicated with jaundice and 158 cases were non-jaundiced. The intraoperative blood volume, length of hospital stay, rate of conversion to open cholecystectomy, rate of incidence of complications, comprehensive complication index(CCI), and Clavin-Dindo classification were compared between the two groups. Results: There was no significant difference in general clinical data between the jaundice group and non jaundice group(P>0.05). There were no significant differences in intraoperative blood loss([24.5±12.4]mL vs. [18.9±15.7]mL), hospital stay([5.8±3.3] d vs. [6.9±3.1]d), rate of conversion to open cholecystectomy(5.4% vs. 5.7%), rate of incidence of complications(8.1% vs. 11.4%), CCI[(5.2±9.8) vs.(8.0±6.1) scores]and rate of Clavin-Dindo classification over level Ⅱ(2.7% vs. 1.3%) between the jaundice group and non jaundice group(P>0.05). Conclusion: Laparoscopic cholecystectomy is safe and feasible for patients with acute cholecystitis complicated with jaundice if preoperative examination indicates that there is no definite common bile duct obstruction caused by bile duct stones or tumors.