慢性胆囊炎行腹腔镜胆囊切除术的手术时机分析

Operative timing analysis of laparoscopic cholecystectomy for chronic cholecystitis

目的探讨慢性胆囊炎行腹腔镜胆囊切除术的手术时机。方法50例行腹腔镜胆囊切除术的慢性胆囊炎患者,按手术时机不同分为对照组和观察组,各25例。对照组在发病72 h后进行择期手术,观察组在发病72 h内进行急诊手术。对比两组手术及术后恢复指标、并发症发生率、手术前后炎症指标。结果观察组手术时间与对照组比较差异无统计学意义(P>0.05);观察组术中出血量(24.75±9.02)ml、住院费用(10^(9)25.64±1237.45)元均少于对照组的(56.37±15.68)ml、(15602.73±1547.28)元,术后疼痛持续时间(25.94±4.83)h、术后排气时间(33.76±9.21)h、住院时间(3.46±0.72)d均短于对照组的(48.63±10.51)h、(48.57±10.69)h、(6.78±1.25)d,中转开腹率4.00%低于对照组的24.00%,差异有统计学意义(P<0.05)。观察组并发症发生率8.00%明显低于对照组的32.00%,差异有统计学意义(P<0.05)。术后,观察组白细胞(WBC)(10.12±1.34)×10^(9)/L、C反应蛋白(CRP)(18.57±5.18)mg/L明显低于对照组的(13.54±1.76)×10^(9)/L、(36.41±6.82)mg/L,差异有统计学意义(P<0.05)。结论慢性胆囊炎行早期腹腔镜胆囊切除术的效果更好,能减少术中出血量,减轻术后炎症反应程度,加快术后恢复速度,降低并发症发生率,提升康复质量。

Objective To discuss the operative timing of laparoscopic cholecystectomy for chronic cholecystitis.Methods A total of 50 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy were divided into control group and observation group according to different operative timing,with 25 cases in each group.The control group underwent elective surgery after 72 h of onset,and the observation group underwent emergency surgery within 72 h of onset.The surgical indicators and postoperative recovery indicators,complication rate,and inflammation indicators before and after operation were compared between the two groups.Results There was no statistically significant difference in operation time between the observation group and the control group(P>0.05).In the observation group,the intraoperative blood loss(24.75±9.02)ml and hospitalization expenses(10925.64±1237.45)yuan were less than(56.37±15.68)ml and(15602.73±1547.28)yuan in the control group;the postoperative pain duration(25.94±4.83)h,postoperative exhaust time(33.76±9.21)h,and hospitalization time(3.46±0.72)d were shorter than(48.63±10.51)h,(48.57±10.69)h,and(6.78±1.25)d in the control group;the conversion rate to laparotomy 4.00%was lower than 24.00%in the control group;all the differences were statistically significant(P<0.05).The complication rate 8.00%in the observation group was significantly lower than 32.00%in the control group,and the difference was statistically significant(P<0.05).After operation,the white blood cell(WBC)(10.12±1.34)×10^(9)/L and C-reactive protein(CRP)(18.57±5.18)mg/L in the observation group were significantly lower than(13.54±1.76)×10^(9)/L and(36.41±6.82)mg/L in the control group,and the difference was statistically significant(P<0.05).Conclusion Early laparoscopic cholecystectomy for chronic cholecystitis is more effective,and can reduce intraoperative blood loss and postoperative inflammatory response,speed up postoperative recovery,lower the complication rates,and improve the quality of rehabilitation.