早期腹腔镜胆囊切除术治疗重症急性胆囊炎的安全性和有效性

Safety and efficacy of early laparoscopic cholecystectomy for severe acute cholecystitis in EGS gradeⅢand above

目的探讨早期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急诊普通外科(emergency general surgery,EGS)Ⅲ级及以上重症急性胆囊炎的安全性及有效性。方法回顾分析2017年1月至2022年6月于华中科技大学同济医学院附属武汉市中心医院接受LC的急性胆囊炎病人1381例,根据病情严重程度不同分为重症组(112例)和普通组(1269例)。分析比较两组术前一般资料、手术时间、术中失血量、中转开腹率、术后转ICU率、围手术期死亡率、术后引流量、术后住院时间及并发症发生率等。结果重症组相较于普通组,手术时间[(100.54±22.23)min比(61.31±10.48)min]、术中失血量[40.00(20.00,60.00)mL比5.00(5.00,10.00)mL]、术后引流量[100.00(60.00,152.50)mL比30.00(20.00,40.00)mL]、术后住院时间[(7.31±2.68)d比(4.03±1.23)d]均有所增多,差异具有统计学意义(P<0.05);重症组中转开腹率为3.57%(P=0.208)、术后转ICU率为4.46%(P=0.297)、围手术期死亡率为0、并发症发生率为7.14%(P=0.133),与普通组相比差异无统计学意义。结论EGSⅢ级及以上重症急性胆囊炎早期行LC治疗,术后并发症发生率等和轻度急性胆囊炎术后相比并不增加,是相对安全、有效的,可作为该类重症急性胆囊炎的一种治疗选择。

Objective To explore the safety and efficacy of early laparoscopic cholecystectomy(LC)for severe acute cholecystitis in emergency general surgery(EGS)grade III and above.Methods A total of 1,381 patients with acute cholecystitis underwent LC from January 2017 to June 2022.They were divided into two groups of severe(n=112)and general(n=1269)according to disease severity.Two groups were compared in terms of preoperative general profiles,operative duration,intraoperative blood loss,intraoperative laparotomy rate,postoperative transfer rate into intensive care unit(ICU),perioperative mortality,postoperative drainage,postoperative hospital stay and complication rate.Results Compared to general group,there were increases in operative duration[(100.54±22.23)vs.(61.31±10.48)min],intraoperative blood loss[40.00(20.00,60.00)vs.5.00(5.00,10.00)mL],postoperative drainage[100.00(60.00,152.50)vs 30.00(20.00,40.00)mL]and postoperative hospital stay[(7.31±2.68)vs.(4.03±1.23)day].There were statistically significant differences(P<0.05);rate of conversion into open abdomen in intensive care group was 3.57%(P=0.208),rate of postoperative transfer to ICU 4.46%(P=0.297),perioperative mortality rate 0 and the incidence of complications was 7.14%(P=0.133).There was no statistically significant difference with general group.Conclusion Early LC of severe acute cholecystitis of EGS grade III and above does not increase the incidence of postoperative complications.It is relatively safe and effective for severe acute cholecystitis.