不同时机行腹腔镜胆囊切除术治疗急性胆囊炎的效果和安全性

Effect and safety of laparoscopic cholecystectomy at different operation timings on acute cholecystitis

目的分析不同时机行腹腔镜胆囊切除术治疗急性胆囊炎的效果和安全性。方法抽取2018年1月至2021年6月解放军联勤保障部队第九九〇医院收治的急性胆囊炎患者180例, 按照发病后实施腹腔镜胆囊切除术的时间将其分为≤72 h组(发病72 h内手术)和>72 h组(发病72 h后手术), 每组90例。比较两组手术优良率、围术期情况、术后胃肠功能恢复情况、炎性因子水平、并发症发生率。结果≤72 h组手术优良率(96.67%, 87/90)高于>72 h组(81.11%, 73/90), P<0.05。≤72 h组术中出血量和腹腔引流量均少于>72 h组(t=38.50、23.31, P均<0.05), 手术时间、体温恢复时间、上腹痛消失时间、住院时间均短于>72 h组(t=31.40、21.68、50.15、5.35, P均<0.05)。≤72 h组肠鸣音恢复时间、肛门排气时间和经口进食时间均短于>72 h组(t=10.95、26.26、40.63, P均<0.05)。两组术后8 h炎性因子水平高于术前, 但≤72 h组增高幅度低于>72 h组(P<0.05)。≤72 h组并发症总发生率(6.67%, 6/90)低于>72 h组(18.89%, 17/90), P<0.05。结论针对急性胆囊炎患者在发病72 h内及时实施腹腔镜胆囊切除术, 可减轻手术创伤和炎性刺激, 降低并发症发生率, 加快术后胃肠功能恢复。

Objective To analyze the effect and safety of laparoscopic cholecystectomy at different operation timings on acute cholecystitis.Methods A total of 180 patients with acute cholecystitis admitted to No.990 Hospital of the Joint Logistic Support Force of the People’s Liberation Army from January 2018 to June 2021 were selected.According to the operation timings of laparoscopic cholecystectomy after the onset of the disease,they were divided into≤72 h group(underwent operation within 72 hours after onset)and>72 h group(underwent operation 72 hours after onset),with 90 cases in each group.The excellent and good rates of the surgical effect,perioperative conditions,postoperative gastrointestinal function recovery,inflammatory factor levels,and complication rates were compared between the two groups.Results The excellent and good rate of the surgical effect in the≤72 h group(96.67%,87/90)was higher than that in the>72 h group(81.11%,73/90),P<0.05.The intraoperative blood loss and abdominal drainage in the≤72 h group were less than those in the>72 h group(t=38.50,23.31,all P<0.05),while the operation time,body temperature recovery time,epigastric pain disappearance time,and hospital stay time in the≤72 h group were shorter than those in the>72 h group(t=31.40,21.68,50.15,5.35,all P<0.05).The recovery time of bowel sounds,anal exhaust time,and oral feeding time in the≤72 h group were shorter than those in the>72 h group(t=10.95,26.26,40.63,all P<0.05).The levels of inflammatory factors at 8 hours after operation in the two groups were higher than those before operation,but the increase in the≤72 h group was lower than that in the>72 h group(P<0.05).The total incidence of complications in the≤72 h group(6.67%,6/90)was lower than that in the>72 h group(18.89%,17/90),P<0.05.Conclusions Laparoscopic cholecystectomy within 72 hours after onset of acute cholecystitis can relieve the surgical trauma and inflammatory stimulation,reduce the incidence of complications,and speed up the postoperative gastrointestinal function recovery.