急性结石性胆囊炎行小切口胆囊切除术与腹腔镜胆囊切除术的疗效分析

目的:分析腹腔镜胆囊切除术与小切口胆囊切除术治疗急性结石性胆囊炎的临床效果.方法:回顾总结2017年5月至2019年8月手术治疗的61例急性结石性胆囊炎患者的临床资料,42例行腹腔镜胆囊切除术(腹腔镜组),19例行开腹小切口胆囊切除术(小切口组).比较两组手术时间、术中出血量、切口长度、术后第1天疼痛评分、引流管留置时...

Analysis of curative effect of small incision cholecystectomy and laparoscopic cholecystectomy for acute calculous cholecystitis

Objective:To summarize and analyze the clinical application effects of laparoscopic cholecystectomy and small incision cholecystectomy in the treatment of acute calculous cholecystitis.Methods:The clinical data of 61 patients with acute calculous cholecystitis from May 2017 to Aug.2019 were retrospectively summarized,according to the methods of operation,patients were divided into two groups:the laparoscopic group(n=42,laparoscopic cholecystectomy)and the small incision group(n=19,open small incision cholecystectomy).The operative time,intraoperative blood loss,incision length,pain score on the first postoperative day,drainage tube indwelling time,hospitalization time,surgical success rate,complications,bowel sound recovery time,anal exhaust time,eating time,defecation time,serum C reactive protein concentration before and after surgery,white blood cell count and granulocyte percentage were compared between the two groups.Results:In the laparoscopic group,the operative time,incision length,drainage tube indwelling time,bowel sound recovery time,anal exhaust time,eating time,defecation time,and hospitalization time were shorter than those in the small incision group,and intraoperative blood loss was less than that in the small incision group.The pain score on the first day after the operation was lower than that of the small incision group,and the serum C reactive protein concentration,white blood cell count,and the percentage of granulocytes on the first postoperative day increased than those before operation,and these indexes were lighter than those of the small incision group,the difference was statistically significant(P<0.05).There was no statistically significant difference in surgical success and complications(P>0.05);laparoscopic exploration showed severe inflammatory edema of the gallbladder triangle in 5 cases,which were converted to laparotomy,and every small incision cholecystectomy was successful.Conclusions:Under the premise of mature laparoscopic technology,laparoscopic cholecystectomy for acute calculous cholecystitis will result in mild postoperative pain,little stress response,quick recovery of gastrointestinal function,and significant curative effect.If the inflammatory edema of the gallbladder triangle is severe or the anatomy is unclear,the operation is safer by switching to laparotomy and small incision cholecystectomy.