摘要
【摘要】目的探讨急性胆囊炎腹腔镜手术时机的选择及中转开腹的影响因素。方法160例行腹腔镜手术的急性胆囊炎患者，按出现症状距手术时间分为四组：24h以内手术为A组（56例）、24～48h手术为B组（42例）、49～72h手术为C组（40例）、72h以后手术为D组（22例），比较各组手术时间、中转开腹、住院时间及住院费用等，并分析影响腹腔镜手术中转开腹的相关因素。结果D组中转开腹率[59．09％（13／22）]明显高于A组[19．64％（11／56）]（P〈0．01）。A组手术时问最短，D组手术时间最长。D组住院时间明显长于其他各组（P〈0．05）。各组住院费用比较差异无统计学意义（P〉0．05）。单因素分析结果显示，白细胞计数、体温、手术时机、胆囊颈部结石嵌顿是影响中转开腹的危险因素（P〈0．05）。多因素回归分析结果显示，白细胞计数和手术时机是中转开腹的独立危险因素（P〈0．05）。结论急性胆囊炎腹腔镜手术中转开腹与白细胞计数、体温、手术时机、胆囊颈部结石嵌顿等因素有关，白细胞计数和手术时机是其独立危险因素。腹腔镜手术的最佳时机为发病后72h内，并且白细胞计数〈15×10^9/L。
Objective To explore the influencing factors and timing of acute cholecystitis laparoscopic surgery. Methods One hundred and sixty acute cholecystitis patients treated with laparoscopic surgery were divided into group A （56 cases, performed treatment within 24 h）,group B （42 cases, performed treatment at 24 - 48 h）, group C （ 40 cases, performed treatment at 49 - 72 h）, group D （22 cases, performed treatment after 72 h）. The operation time, rate of conversion to laparotomy, length of stay and average costs were compared among four groups and analyzed the impact of laparoscopic surgery conversion to laparotomy. Results The rate of conversion to laparotomy of group D [59.09%（13/22） ] was significantly higher than that in group A [ 19.64% （11/56） ] （P 〈 0.01 ）. The operation time of group A was the shortest and group D was the longest. The length of stay of group D was significantly longer than other groups （P 〈 0.05 ）.The costs of the four groups had no significant difference（P 〉 0.05 ）. Single factor analysis showed that white blood cell （WBC） count, body temperature, timing of surgery, gallbladder neck calculi incarceration were correlated with conversion to laparotomy （P 〈 0.05 ）. Multifactor analysis showed that WBC count, timing of surgery were independent risk factors of conversion to laparotomy （P 〈 0.05 ）. Conclusions WBC count, body temperature, timing of surgery, gallbladder neck calculi incarceration are correlated with acute cholecystitis laparoscopic surgery conversion to laparotomy. While WBC count and timing of surgery are independent risk factors. The best time of laparoscopic surgery is within 72 h and WBC count 〈 15 × 10^9/L.
出处
《中国医师进修杂志》
2012年第26期14-17,共4页
Chinese Journal of Postgraduates of Medicine
关键词
胆囊炎
急性
腹腔镜检查
危险因素
中转开腹率
手术时机
Cholecystitis,acute
Laparoscopy
Risk factors
Rate of conversion to laparotomy
Timing of surgery
