摘要
目的探讨急性胆囊炎患者腹腔镜胆囊切除术时机的选择,及其对临床效果及安全性的影响。方法选择2015年1月至2017年3月在我院实施腹腔镜胆囊切除术的120例急性胆囊炎患者进行前瞻性随机研究,通过随机数字表法分为3组,其中早期组40例,发病至手术时间≤3 d,延期组40例,发病至手术时间4~21 d,择期组40例,先给予保守治疗,待急性期症状消失,至少距发病21 d以上后再实施手术。比较3组围术期情况、中转开腹术率及术后并发症。结果早期组和择期组术中出血量、下床活动时间、肛门排气时间比较均无显著差异(P>0.05),早期组和择期组术中出血量明显少于延期组,下床活动时间、肛门排气时间均明显短于延期组(P<0.05),早期组手术时间、住院时间明显短于延期组和择期组(P<0.05);延期组中转开腹率为22.5%,明显高于早期组和择期组的5%、5%(P<0.05);3组胃肠损伤、肝脏损伤、感染、胆漏、肠瘘等发生率比较均无显著差异(P>0.05)。结论急性胆囊炎患者早期(3 d内)实施腹腔镜胆囊切除术效果更为显著,可缩短手术时间,降低中转开腹率和并发症,有利于术后恢复。
Objective To study the timing of laparoscopic cholecystectomy（LC） on clinical efficacy and safety in patients with acute cholecystitis. Methods A total of 120 patients with acute cholecystitis who underwent laparoscopic cholecystectomy in our hospital from January 2015 to March 2017 were selected and divided into three groups according to the random number table. Among them,40 patients in the early group were treated by laparoscopic cholecystectomy within 3 days. 40 cases in the deferred group received LC in 4 ~ 21 days after the onset of acute cholecystitis. And the other 40 patients of elective group were given conservative treatments before an implementation of surgery. The perioperative period,the rate of laparotomy and postoperative complications of the three groups were compared. Results There was no significant difference in bleeding volume,ambulation time and anus exhaust time between the early group and the elective group（P〉0. 05）. The bleeding volume in the early group and the elective group was significantly less than that of the deferred group（P〈0. 05）. Operation time and hospitalization time in the early group were significantly shorter than that of the deferred and elective groups（P〈0. 05）. The laparotomy rate was 22. 5% in the deferred group,which was significantly higher than that of the early group and the selective group. The incidence of gastrointestinal injury,liver injury,infection,bile leakage and intestinal fistula in the three groups showed no significant difference（P〉0. 05）. Conclusion Laparoscopic cholecystectomy in early stage（less than 3 d） is more effective in patients with acute cholecystitis,which can shorten operation time,reduce the laparotomy conversion rate and complications,and is beneficial to postoperative recovery.
出处
《中国现代手术学杂志》
2017年第5期340-343,共4页
Chinese Journal of Modern Operative Surgery
基金
泰州市科技计划项目(编号:TS201341)
关键词
急性胆囊炎
腹腔镜检查
胆囊切除术
手术时机
acute cholecystitis
laparoscopy
cholecystectomy
operation opportunity
