急性结石性胆囊炎LC手术时机及中转开腹影响因素的探讨

【目的】探讨急性结石性胆囊炎腹腔镜手术预后与手术时机的关系，并对中转开腹的影响因素进行分析。【方法】回顾性分析本院2007年至2011年收治的急性结石性胆囊炎腹腔镜手术患者119例的临床资料，依据出现症状到手术时间长短分为三组：48h以内的49例（A组），48～72h的41例（B组），大于72h的29例（C组），比较三组患者手术时问、中转开腹率、并发症和住院时间，并分析影响三组患者中转开腹的因素。【结果】A组手术时间最短，与B组、C组比较均有统计学差异（P〈0．05），C组在中转开腹率、并发症和出院时问方面显著高于A组和B组（P〈0．05），但A组和B组比较无统计学差异（P〉0．05）；Logistic回归结果显示白细胞计数、胆囊颈部结石嵌顿和手术时机是中转开腹的影响因素，且随着0R值增大，危险性越高。【结论】急性结石性胆囊炎症状发作后48h内是腹腔镜手术的最佳时机，白细胞计数、胆囊颈部结石嵌顿和手术时机是中转开腹的危险因素，只要掌握正确时机，适时中转手术，急性结石性胆囊炎腹腔镜胆囊切除术是安全可行的。

Study on Operation Opportunity of Laparoscopy for Acute Lithic Cholecystitis and the Influential Factors of Conversion to Laparotomy

Objective] To explore the relationship between prognosis and operation opportunity of laparoscopy for acute lithic eholecystitis, and to analyze the influential factors of conversion to laparotomy. Methods]The clinical data of 119 patients with acute lithic cholecystitis undergoing laparoscopy in our ＇hospital from 2007 to 2011 were retrospectively analyzed. According to the duration from the onset of the symptoms to the operation, all pa tients were divided into group A（ n =49, within 48h）, group B（ n =41, within 48-72h） and group C（ n =29, more than 72h）. The operation time, the rate of conversion to laparotomy, complications and hospital day were compared among 3 groups. The influential factors of conversion to aparotomy of patients in 3 groups were ana- lyzed. Results] The operation time of group A was the shortest, and there was significant difference between group A and other 2 groups（ P 〈0.05）. The rate of conversion to laparotomy, complications and hospital time in group B were significantly higher than those in other 2 groups（ P 〈0.05）, but there was no significant difference between group A and group B（ P 〉0.05）. Logistic regression analysis showed that white blood cell count, gall- bladder neck stone impaction and the timing of surgery were the influential factors of conversion to laparotomy. The risk factors increased with the OR. Conclusion] The best time for laparoscopic surgery is within 48h after the onset of symptoms of acute lithic cholecystitis. White blood cell count, gallbladder neck stone impaction and timing of surgery are the risk factors of conversion to laparotomy. If the correct opportunity is grasped and the conversion to laparotomy is performed in time, laparocopic cholecystectomy for acute lithic cholecystitis is safe and feasible.