腹腔镜下胆囊切除术治疗急性胆囊炎的最佳时机及影响中转开腹的因素分析

Acute cholecystitis laparoscopic cholecystectomy surgery laparotomy factor

目的腹腔镜下胆囊切除术治疗急性胆囊炎的最佳时机及影响中转开腹的因素进行分析。方法选择我院收治的急性结石性胆囊炎患者300例,根据手术时机分为甲、乙、丙、丁四组。其中甲、乙、丙三组从急性发作到手术时间分别为48 h、72 h、大于72 h。丁组患者为经过严格的术前对症治疗后进行择期手术,收集相关的临床资料,并用SPSS20.0软件进行统计分析。结果甲、丁患者手术时间、术后腹腔引流量、并发症、中转开腹率较乙、丙组患者少,差异有统计学意义(P<0.05),甲组中转开腹率与丁组比较,甲组中转开腹率低于丁组,差异有统计学意义(P<0.05),体温、右上腹肌紧张、能否触及胆囊、白细胞计数、B超能否看见胆囊肿大、胆囊壁的厚度、胆囊颈部结石嵌顿与中转开腹有关(P<0.05),手术时机、白细胞计数、胆囊颈部结石嵌顿是急性结石性胆囊炎腹腔镜胆囊切除术中中转开腹独立危险因素(OR=2.382、3.125、2.142,P<0.05)。结论急性结石性胆囊炎可尽早进行手术,发作48 h内是腹腔镜手术治疗最佳时机,其次可先行保守治疗后再择期手术治疗,可减少手术风险及并发症,中转开腹受到手术时机选择、血象及结石位置影响,应综合考虑提高腹腔镜手术成功率。

Objective To analysis the best opportunity and the influencing factors of the treatment for Laparoscopic cholecystectomy. Methods According to the operation time of patients,Three hundred cases of patients with acute calculous cholecystitis were divided into four groups. Among them,A,B,C group from acute to operation time was 48 h,72h,more than 72 h,respectively. The patients of D group of after strict preoperative symptomatic treatment for electie colorectal surgery,collect related clinical data,the software of SPSS20. 0 was used for statistical analysis. Results Compared with the group of B and C,the group of A and D’s operative time,postoperative abdominal drainage,complications,laparotomy rates were less than the group of B,C,the difference was statically significant( P < 0. 05),compared with D group,A group’s operate rates were less,the difference was statically significant( P <0. 05),temperature,upper abdominal muscle tension,whether can reach the gallbladder,white blood cell counts,whether the ultrasound can see gallbladder enlargement,the thickness of gallbladder wall,gall bladder neck calculus incarcerated are related to transfer laparotomy( P < 0. 05),operation time,white blood cell count,the gallbladder neck calculus incarcerated is acute calculous cholecystitis laparoscopic cholecystectomy transit open independent risk factors,( OR = 2. 382、3. 125、2. 142,P < 0. 05). Conclusion Acute cholecystitis surgery as soon as possible,within 48 h attack is the best time of laparoscopic surgery,followed by conservative treatment can first before elective surgery can reduce the risks and complications of surgery,timing of surgery by laparotomy,blood and stone location effects,should be considered to improve the success rate of laparoscopic surgery.