腹腔镜胆囊切除术治疗急性胆囊炎手术时机探讨

Discussion on operative opportunity of laparoscopic cholecystectomy for acute cholecystitis

目的探讨腹腔镜胆囊切除术(LC)治疗急性胆囊炎的手术时机。方法前瞻性纳入2016-06—2020-12于镇江市中医院普外科行LC治疗的88例急性胆囊炎患者。根据手术时机分为早期组(72 h内)和延期组(72 h以后)。比较2组患者的基线资料、术中情况、术后临床指标,统计住院费用。结果共纳入88例患者,每组44例。2组患者的基线资料及术后并发症发生率差异无统计学意义(P>0.05)。早期组的手术时间、术中出血、中转开腹率,以及术后离床活动时间、肛门恢复排气时间、住院时间均短于延期组;住院费用少于延期组。差异均有统计学意义(P<0.05)。结论与发病72 h后行LC比较,对急性胆囊炎患者于发病72 h内施术,能降低中转开腹率,利于术后康复和缩短住院时间,并可减少患者的住院费用。但该结论尚需大样本量的前瞻性随机对照研究予以证实。

Objective To evaluate the operative opportunity of laparoscopic cholecystectomy(LC)for acute cholecystitis.Methods Eighty-eight patients with acute cholecystitis who received LC in general Surgery Department of Zhenjiang Hospital of Traditional Chinese Medicine from June 2016 to December 2020 were prospectively enrolled.According to the time of operation,the patients were divided into early group(within 72 h)and delayed group(after 72 h).The baseline data,intraoperative conditions and postoperative clinical indicators of patients in the two groups were compared,and hospitalization expenses were counted.Results A total of 88 patients were included,44 in each group.There was no significant difference in baseline data and incidence of postoperative complications between the two groups(P>0.05).The operative time,intraoperative bleeding volume,laparotomy rate,postoperative ambulation time,anal recovery exhaust time and hospital stay were shorter in the early group than that in the delayed group.Hospitalization costs were less in the delayed group.The differences were statistically significant(P<0.05).Conclusion Compared with LC performed after the 72h of the onset,Patients with acute cholecystitis were operated within 72h of the onset can reduce laparotomy rate,facilitate postoperative recovery and shorten hospitalization day,and reduce the hospitalization cost of patients.However,this conclusion needs to be confirmed by prospective randomized controlled studies with a large sample size.