肺部并存病患者腹腔镜与开腹胆囊切除术的对比观察

Comparison of laparoscopic and open cholecystectomy in patients with pre-existing pulmonary diseases

目的 探讨肺部并存病患者腹腔镜胆囊切除术的安全性。方法 2 0 0 3年 1月 36例伴肺部合并病的患者行胆囊切除术 ,其中LC组 16例 ,OC组 2 0例。对比分析两组患者术后恢复活动时间、住院时间、恢复饮食时间和腹胀发生率、伤口及肺部并发症发生率。结果 两组均无手术死亡。术后恢复活动时间分别为(2 4± 6 .8)h和 (6 8± 16 .3)h ,恢复饮食时间分别为 (2 6± 8.4 )h和 (6 8± 2 2 .4 )h ,住院时间分别为 (4.4± 2 .2 5 )d和 (10 .6± 5 .38)d。腹胀发生率分别为 6 .7% (1/ 16 )和 35 .0 % (7/ 2 0 ) ,切口感染 (和 /或裂开 )率分别是 0和15 .0 % ,肺部感染率分别为 6 .6 %和 2 5 .0 %。结论 肺部并存病患者行腹腔镜胆囊切除术是安全可行的 ,具有并发症发生率低、术后恢复快、住院时间短的特点。

Objective: To discuss the feasibility and safety of laparoscopic cholecystectomy on the patients with pre-existing pulmonary diseases.Methods: Thirty-six patients with pre-existing pulmonary diseases undergoing cholecystectomy (16 in LC group and 20 in OC group,respectively) were reviewed. Interval to return to full activities,hospitalization and incidence of complications in each group were compared respectively.Results: There was no operative death either in LC group or in OC group. Interval to return to full activities in LC and OC group were (24±6.8)h and (68±16.3)h respectively,and post-operative hospital stay in LC group was shorter than that in OC group (4.4±2.25 d vs10.6±5.38 d). Resumption of normal diet in LC group was also significantly shorter than that in OC group(26±8.4h vs 68±22.4 h). Abdominal distension occurred in 1(6.7%) case of LC group and 7(35%) cases of OC group. The rate of wound infection and/or wound dehiscence in LC group was higher than that in OC group(15% vs 0%). The incidence of pulmonary infection was 6.7% in LC group,which was significantly lower than that in OC group(25%). Conclusions: LC is a safe and feasible operation on the patients with pre-existing lung diseases. Comparing with OC,LC possesses some advantages of shorter interval to return to full activities after operation,shorter hospitalization and lower incidence of wound and pulmonary complications.