腹腔镜与开腹手术治疗急性坏疽性胆囊炎的临床分析

目的对比分析腹腔镜与开腹手术在急性坏疽性胆囊炎手术治疗中的优越性。 方法收集2010年1月至2015年10月在解放军总医院手术治疗的84例急性坏疽性胆囊炎患者，其中53例行腹腔镜胆囊切除术(LC组)，31例行开腹胆囊切除术(OC组)，对比研究两组手术方式在术中与术后的疗效差异。 结果84例手术均获成功。两组手术时间和住院费用比较，差异无统计学意义(P>0.05)；术中出血量[(86.7 ±12)ml vs (120.4 ± 18) ml]、切口长度[(3.1 ± 0.4)cm vs (13.2 ± 2.7)cm]、术后8 h疼痛评分[(5.3 ± 2.1)分 vs (8.6 ± 1.9)分]、术后排气时间[(20.6 ± 6.5) h vs (34.5 ± 4.7) h]、切口感染率(1.8% vs 12.9%)、住院时间[(7.6 ± 1.8) d vs (13.4 ± 4.8)d]、术前及术后总胆红素的变化比较，差异有统计学意义(P<0.05)，LC组优于OC组。 结论在严格的手术适应证选择和精密的手术操作的前提下，急性坏疽性胆囊炎应用LC治疗，痛苦小、恢复快、住院时间短，值得临床推广。

Comparative analysis between laparoscopic surgery and laparotomy in the treatment of acute gangrenous cholecystitis

ObjectiveTo compare the superiority between laparoscopic surgery and laparotomy in treating acute gangrenous cholecystitis. MethodsThe 84 patients with acute gangrenous cholecystitis were collected from Jan. 2010 to Oct. 2015, which were divided into LC group (53 cases) and OC group (31 cases). The intraoperative and postoperative situations of the two groups were compared. ResultsAll the 84 patients were operated successfully. No difference existed in operation time and costs(P>0.05), but the difference in amount of intraoperative bleeding[(86.7 ±12)ml vs (120.4 ± 18) ml], length of incision[(3.1 ± 0.4)cm vs (13.2 ± 2.7)cm], pain rating index[(5.3 ± 2.1) marks vs (8.6 ± 1.9) marks], intestinal function recovery time[(20.6 ± 6.5) h vs (34.5 ± 4.7) h], wound infection rate (1.8% vs 12.9%), hospital stay time[(7.6 ± 1.8) d vs (13.4 ± 4.8)d] and changes of serum bilirubin level was statistically significant (P<0.05), The LC group was better than OC group. ConclusionsUnder the strict selection of operation indications and premise surgery operation, LC in treating acute gangrenous cholecystitis has short hospitalization time and low cost of hospitalization.