急诊与择期腹腔镜胆囊切除术对慢性结石性胆囊炎急性发作的治疗效果

Effect of Emergency and Elective Laparoscopic Cholecystectomy on Acute Attack of Chronic Calculus Cholecystitis

目的:对比分析急诊腹腔镜胆囊切除术(LC)与保守治疗后择期行LC在慢性结石性胆囊炎(CCC)急性发作中的临床效果。方法:选择2021年1月—2024年1月于萍乡市第三人民医院就诊的78例CCC急性发作患者为研究对象,按随机数字表法分为急诊LC组、择期LC组,各39例。急诊LC组于发病72 h内行急诊LC,择期LC组保守治疗后行择期LC。比较两组围手术期指标、血清指标、胃肠功能恢复情况及术后并发症。结果:择期LC组术中失血量少于急诊LC组,手术时间、术后住院时间均短于急诊LC组(P<0.05)。术后1 d,两组间接胆红素(IBIL)、总胆汁酸(TBA)水平均较术前明显升高,择期LC组IBIL、TBA、钙离子(Ca^(2+))水平均较急诊LC组低(P<0.05)。择期LC组肠鸣音恢复、排气、排便时间均较急诊LC组早(P<0.05)。择期LC组术后并发症发生率低于急诊LC组(P<0.05)。结论:保守治疗后择期行LC可以减少CCC急性发作患者术中失血量,缩短术后恢复时间,术后并发症更少。

Objective:To compare and analyze the clinical effect of emergency laparoscopic cholecystectomy(LC)and selective LC after conservative therapy in acute attack of chronic calculous cholecystitis(CCC).Method:A total of 78 patients with acute attack of CCC treated in the Third People's Hospital of Pingxiang City from January 2021 to January 2024 were selected as the study objects,and were divided into the emergency LC group and the elective LC group according to random number table method,with 39 cases in each group.The emergency LC group received emergency LC within 72 h of onset,and the elective LC group received elective LC after conservative therapy.Perioperative indexes,serum indexes,gastrointestinal function recovery and postoperative complications were compared between the two groups.Result:The intraoperative blood loss in the elective LC group was less than that in the emergency LC group,and the operative time and postoperative hospital stay were shorter than those in the emergency LC group(P<0.05).1 day after surgery,the levels of indirect bilirubin(IBIL)and total bile acid(TBA)in both groups were significantly higher than those before surgery,and the levels of IBIL,TBA and calcium ion(Ca^(2+))in the elective LC group were lower than those in the emergency LC group(P<0.05).The time of bowel sound recovery,exhaust gas and defecation in elective LC group were earlier than those in emergency LC group(P<0.05).The incidence of postoperative complications in the elective LC group was lower than that in the emergency LC group(P<0.05).Conclusion:Elective LC after conservative therapy can reduce intraoperative blood loss,shorten postoperative recovery time and reduce postoperative complications in patients with acute attack of CCC.