急性胆囊炎行腹腔镜胆囊切除手术时机的前瞻性研究

[摘 要] 目的 探讨急性胆囊炎行腹腔镜胆囊切除术的手术时机。方法 将西安市第九医院2014年1月至2017年10月收治的急性胆囊炎患者随机分为急诊手术组、延期手术组、择期手术组三组,每组40例,进行前瞻性对照临床研究。急诊手术组发病72 h内行腹腔镜胆囊切除术;延期手术组入院后经抗感染、对症治疗,腹痛缓解,体温血象正常,发病4～14 d行腹腔镜胆囊切除术;择期手术组经抗感染、对症治疗,腹痛缓解,体温血象正常,3个月后择期行腹腔镜胆囊切除术。观察三组中转开腹率、出血量、手术时间、术后并发症、住院天数、总费用、术者评定的手术难度。结果 延期手术组1 例由于胆囊三角解剖不清而中转开腹,其他两组无中转开腹。择期手术组、急诊手术组、延期手术组在手术时间和术中出血量方面依次增加（P＜0．01）。早期手术组的住院时间及住院费用明显少于延期手术组、择期手术组（P＜0．01）。延期手术组的手术难度明显高于其他两组（P＜0．01）;急诊手术组的手术难度与择期手术组无统计学差异（P＞0.05）。三组病例并发症的发生无差异。结论 急性胆囊炎患者行急诊、延期、择期腹腔镜胆囊切除术均是安全的。发病72 h内早期手术,具有操作相对容易,立即解除病痛,住院时间短,治疗费用低的优势。     

急性胆囊炎320例腹腔镜手术时机的评价与操作体会

目的　对急性胆囊炎腹腔镜手术时机进行评价 ,并总结手术操作体会。方法　将 32 0例急性胆囊炎患者分 3组施行LC。结果　早期手术组 16 4例 ,中转手术 8例 (0 .5 % ) ;限期手术组 5 1例 ,中转手术 7例 (13.7% ) ;择期手术组 10 5例 ,中转手术 5例 (0 .5 % )。平均手术时间分别为早期组4 6min、限期组 89min及择期组 35min ,平均住院时间分别为 5 .4d、13.6d及 8.7d。本组患者均痊愈出院。结论　急性胆囊炎在发病早期是行LC的理想时机 ;Calot三角的良好显露、正确处理胆囊管和胆囊动脉是LC成功的关键 ;正确对待中转手术和掌握中转手术的指征是LC的安全保证措施     

早期与延期腹腔镜胆囊切除术治疗急性胆囊炎对比研究

[摘 要] 目的 对比急性胆囊炎的早期和延期腹腔镜胆囊切除术（LC）疗效。方法 选取武义县第一人民医院2015年4月至2017年4月的急性胆囊炎患者120例,根据手术方式不同,分为2组,每组60例,早期LC组：发病72 h内行LC;延期LC组：保守治疗延期2～3个月后行LC。比较两组患者手术时间、术后住院时间、平均住院时间、中转开腹率、术后并发症、术后疼痛评分及术后患者满意度。结果 两组均手术成功,无死亡病例。两组患者在手术时间、术后住院时间、中转开腹率、术后并发症方面差异无统计学意义（P > 0.05）。在平均住院时间、术后疼痛评分及术后患者满意度方面早期LC术组明显优于延期LC组,差异存在统计学意义（P < 0.05）。结论 急性胆囊炎早期行腹腔镜胆囊切除术安全、经济、住院时间短、痛苦小、恢复块、患者满意度高,适于临床推广。     

老年人急性胆囊炎的腹腔镜手术治疗

目的:探讨老年人急性胆囊炎的临床特点,更好地把握腹腔镜胆囊切除(LC)术的时机和方法。方法:回顾分析32例老年人急性胆囊炎LC的临床资料,比较早期(急性发作48h内)LC及延期(急性发作48h后)LC的治疗结果。结果:早期及延期LC均获成功,患者全部治愈,未发生严重并发症;但延期LC的平均手术时间及术后平均住院日期较长。结论:老年人急性胆囊炎病情进展快,手术难度大、风险高;只要高度重视围手术期的处理,把握手术时机及技巧,早期LC是安全、可行的;除病情危重不能耐受手术者外,多数患者均应尽早施行LC。     

急性胆囊炎腹腔镜手术时机选择与费用关系

目的:探讨急性胆囊炎腹腔镜手术的时机选择,分析其与住院费用的关系。方法:回顾分析2004年1月至2010年12月为427例急性结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料。按胆囊炎发作至手术的时间分为早期手术组(ELC)、延期手术组(DLC)和择期手术组(SLC)。结果:3组患者并发症发生率差异无统计学意义(P>0.05)。ELC组手术时间平均(63.65±15.63)min,术中出血量平均(64.26±32.04)ml,平均住院(4.74±2.22)d,住院费用平均(10 504±1 982)元,中转开腹率2.7%。DLC组手术时间平均(94.24±29.51)min,术中出血量平均(174.95±64.39)ml,平均住院(8.00±3.83)d,住院费用平均(15 230±2 267)元,中转开腹率8.3%。SLC组手术时间平均(65.35±14.49)min,术中出血量平均(65.44±38.91)ml,平均住院(13.91±4.38)d,住院费用平均(19 032±4 495)元,中转开腹率2.2%。DLC组手术时间、术中出血量及中转开腹率明显高于ELC组、SLC组(P<0.05)。3组住院时间、住院医疗费用按病程时间依次增加(P<0.05)。结论:急性胆囊炎早期手术安全有效,并可减少住院时间,降低医疗费用,在治疗结果和生活质量上均具有优势。     

老年急性胆囊炎早期及延期腹腔镜胆囊切除术临床分析

目的比较早期及延期腹腔镜胆囊切除术(LC)治疗老年急性胆囊炎的效果。方法根据不同手术时机将93例接受LC治疗的老年急性胆囊炎患者分为早期组51例和延期组42例。2组均在发病7 d内入院治疗。早期组在入院1~3 d内行LC。延期组先行抗感染治疗,症状改善后6~8周行LC术。比较2组治疗效果。结果 2组手术时间差异无统计学意义(P0.05)。早期组术中出血量、术后肛门排气时间、住院时间、中转开腹率及并发症发生率均低于延期组,差异有统计学意义(P0.05)。结论与延期手术治疗相比,早期LC术治疗老年急性胆囊炎,术后并发症发生率低,效果更显著。     

老年人结石性胆囊炎急性发作时腹腔镜手术61例体会

目的探讨老年结石性胆囊炎急性发作时腹腔镜胆囊切除术(LC)的时机和方法。方法总结分析了61例老年结石性胆囊炎急性发作时行LC病例的临床资料。比较发病72h以内(早期)和72h以外(延期)两组的治疗效果。结果全组病例无严重并发症发生，但延期组的平均手术时间、平均术后住院日和平均术后下床活动时间均较长，早期组LC全部成功，延期组中转手术2例(8．7％)。结论老年人结石性胆囊炎急性发作时早期行LC是安全的，延期施行LC要极为谨慎。     

急性结石性胆囊炎行腹腔镜下胆囊切除术手术时机选择及疗效分析

比较急性胆囊结石胆囊炎患者行早期及延期腹腔镜胆囊切除术(LC)的疗效。回顾性分析2014年1月—2017年12月185例急性结石性胆囊炎行LC患者的临床病理资料,比较早期LC组及延期LC组术前体格检查、实验室和影像学检查结果及术中、术后恢复情况。早期LC组80例,延期LC组105例;两组在性别、年龄、既往上腹部手术史、合并其他疾病、吸烟史及BMI等方面的差异无统计学意义(P0.05)。尽管延期手术组的中转开腹率更高,但组间差异并无统计学意义(P0.05)。常见的术后并发症发生率两组间亦差异无统计学意义(P0.05),早期LC组平均住院天数更短[(5.56±2.44)d比(7.82±1.69)d],差异有统计学意义(P0.001)。急性胆囊炎早期行LC安全、可行,且可显著缩短住院时间。     

腹腔镜胆囊大部切除治疗急性坏疽性胆囊炎的临床分析

目的 探讨腹腔镜胆囊大部切除治疗急性坏疽性胆囊炎的临床疗效.方法 回顾120例急性坏疽性胆囊炎患者实施腹腔镜胆囊大部切除术后、观察其疗效及并发症的发生率.结果 120例急性坏疽性胆囊炎患者均成功施行腹腔镜胆囊大部切除、手术成功率为100%.平均手术时间(60.2±29.2) min、平均住院时间4～7 d、平均引流管留置时间2～5 d.术后无并发症发生.除择期手术组与急诊手术组手术时间(35.0±10.0) min vs.(55.0±12.0) min两组差异有统计学意义,P<0.05外,其他无统计学意义.结论 腹腔镜胆囊大部切除术治疗急性坏疽性胆囊炎是安全、有效的方法之一.     

腹腔镜胆囊切除术治疗急性结石性胆囊炎332例

目的总结腹腔镜胆囊切除术（LC）治疗急性结石性胆囊炎的经验。方法回顾性分析2009年6月至2011年6月332例急性结石性胆囊炎患者的临床资料,采用三孔法或四孔法行LC。结果 313例成功施行LC,平均住院4.9d。19例中转开腹。仅1例出现术后淋巴漏,留置腹腔引流,13d后拔除引流管后出院,住院17d。结论急性结石性胆囊炎如有手术指征,应尽早手术,LC可减少患者的住院时间,减少抗菌药物的应用。     

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??Timing of laparoscopic cholecystectomy for acute cholecystitis??an analysis of 647 cases XU Jun, ZHAI Bo, GUAN Ying-hui, et al. Department of General Surgery, the Fourth Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author??XU Jun??E-mail??zaibo1999@yahoo.com.cn
Abstract Objective To explore the optimal timing for laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. Methods The clinical data of 647 patients with acute cholecystitis performed laparoscopic cholecystectomy from January 2005 to January 2010 in the Department of General Surgery, the Fourth Hospital of Harbin Medical University were analyzed retrospectively. Results According to the interval, 647 patients were divided into 3 groups. The patients in the first (n=212), second (n=238) and third (n=197) group performed LC were within 72h, during 72h-3w, and beyond 3w, respectively. There was no significant difference among 3 groups. Mean operative time and blood losses in the second group were more than those in the first and the third group significantly??P<0.05??. There was no significant difference in postoperative complication among 3 groups. Postoperative stay was 3-23 days (mean 5.5), 3-28 days (mean 7.5), 6-45days (mean 11.7) in the first, second and third group, respectively. The cost was RMB 6-19 thousand yuan (mean 11 thousand), 8-24 thousand yuan (mean 15 thousand), 15-36 thousand yuan (mean 23 thousand) in the first, second and third group, respectively. The postoperative stay and cost in the first, second and third group were increased gradually. Conclusion The timing for LC in patients with acute cholecystitis should be within the shortest interval after onset of symptoms no matter whether the interval is within 72 h or not. On average early laparoscopic cholecystectomy is less expensive and results in better quality of life.     

老年人急性胆囊炎的腹腔镜手术治疗

目的:探讨腹腔镜手术治疗方法在老年人急性胆囊炎的临床疗效和安全性。方法:将2006年1月—2012年5月138例急性胆囊炎老年患者随机分成两组,分别行腹腔镜胆囊切除术(腔镜组,70例)和剖腹胆囊切除术(开腹组,68例),对比两组患者手术时间、肠功能恢复时间、住院时间、术后并发症。结果:腔镜组手术时间、肠功能恢复时间以及住院时间均短于开腹组(均P<0.05),两组术中出血量差异无统计学意义(P>0.05),腔镜组术后并发症明显少于开腹组(P<0.05)。结论:腹腔镜手术治疗方法在老年人急性胆囊炎中具有理想疗效,手术时机的选择与操作的熟练程度是治疗成功的关键。     

腹腔镜治疗急性结石性胆囊炎50例的临床研究

目的研究探讨腹腔镜技术在急性结石性胆囊炎治疗中的安全可靠性。方法通过我科2013年1月至2016年1月收治的50例急性结石性胆囊炎患者的临床资料,回顾分析腹腔镜治疗急性结石性胆囊炎的疗效。其中对照组开腹胆囊切除术(OC)40例,试验组腹腔镜胆囊切除术(LC)50例。对比分析两组的手术时间、术后恢复及并发症情况。结果 LC组的切口愈合时间及手术时间均低于OC组(P0.05)。腹腔镜胆囊切除术除5例中转开腹,余术后无胆漏、胆道狭窄等严重并发症。结论在术者拥有熟练的腹腔镜操作技术的前提下,大多数急性结石性胆囊炎患者行LC是安全可行的。与开腹手术相比,有一定的优势。但仍存在一定的手术风险。     

The efficacy of laparoscopy in acute cholecystitis.

OBJECTIVE: To evaluate the role of laparoscopic cholecystectomy in acute cholecystitis and establish the outcomes of this treatment modality at North Oakland Medical Centers. METHODS: This was a retrospective analysis over a three-year period (January 1, 1994 to December 31, 1996), performed at a University-affiliated urban teaching hospital, North Oakland Medical Centers, Pontiac, Michigan. Five hundred and fifty-seven patients underwent surgical treatment for gallbladder disease; 88 patients had acute cholecystitis, and 469 patients had chronic cholecystitis. Acute cholecystitis patients underwent surgery within 72 hours of the onset of symptoms; the patient's selection for laparoscopic cholecystectomy or open cholecystectomy depended on severity of disease, co-morbid factors and surgeon's preference. The parameters of age, gender, operating (OR) time, length of stay, complications, conversion rates from laparoscopic cholecystectomy to open cholecystectomy, and cost were compared in patients who underwent laparoscopic cholecystectomy and/or open cholecystectomy. RESULTS: Patients chosen to undergo laparoscopic cholecystectomy for acute cholecystitis tended to be younger females. Patients treated with laparoscopic cholecystectomy for acute cholecystitis had shorter OR times and LOS compared to patients treated with open cholecystectomy for acute cholecystitis. Conversion rates (CR) were 22% in acute cholecystitis and 5.5% in chronic cholecystitis during the study period; CR diminished considerably between the first and third year. Complications were also lower in patients who underwent laparoscopic cholecystectomy vs. open cholecystectomy. CONCLUSIONS: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for acute cholecystitis; however, the surgical approach should be cautionary because of the spectrum of potential technical hazards. CR is improving as surgeons gain experience.     

Urgent cholecystectomy in acute cholecystitis: laparoscopy or laparotomy?

Early cholecystectomy is the best policy in the case of acute cholecystitis. The aim of this retrospective study is to evaluate the current treatment of choice of acute calculous cholecystitis, as seen in our experience and in the literature data. Between January 1997 and July 2000, 150 patients were operated on for cholecystectomy. In the group of 30 patients (20%) with acute cholecystitis, 15 patients (50%) were managed with laparoscopic approach while 15 patients (50%) with traditional operation. At the beginning the Authors chose the open via for understand the pathologic findings of acute cholecystitis, then they always preferred the laparoscopic approach. Comparison between two groups concerned the interval between onset of symptoms and operation, postoperative mortality and morbidity rates, postoperative hospital stay and follow up. Statistical analysis was performed by the Student's t-test and the chi-square test. Both groups were homogeneous with regard to sex, age and onset of symptoms. There were no deaths and morbidity rate in the laparoscopic group was 20% versus 40% (p = ns). The average postoperative hospital stay in the laparoscopic group was 5.6 days versus 10.5 days (p = 0.046). The conversion rate into laparotomy was 6.6% (1 case). There has been one case of incisional hernia in the open group at a mean follow up of 20 month. Early laparoscopic cholecystectomy is the treatment of choice of acute cholecystitis because of a lower postoperative morbidity rate and a significant shorter hospital stay.     

Early surgical treatment of acute cholecystitis. A retrospective comparative study of the laparoscopic and open approaches

The aim of this retrospective study was to compare the results of laparoscopic and open early cholecystectomy in patients with acute cholecystitis. From January 1997 to October 2000, 168 patients underwent cholecystectomy in our institution. Of the 35 patients (20.8%) with acute cholecystitis, 20 patients (57.1%) were operated on laparoscopically and the other 15 patients (42.9%) with the traditional open approach. The two groups were similar in terms of age, sex and onset of symptoms. The postoperative morbidity was 15.0% in the laparoscopic group versus 40.0% in the open group. The average postoperative hospital stay in the laparoscopic group was 5.1 days as compared to 10.5 days in the open group (P = 0.013). The conversion rate to laparotomy was 5.0% (1 case). At follow-up there has been one case of incisional hernia in the open group. Early laparoscopic cholecystectomy for acute cholecystitis was associated with a lower postoperative morbidity rate and significantly earlier patient discharge.     

The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis

BACKGROUND: Laparoscopic cholecystectomy is now used in the management of acute cholecystitis. Under these circumstances unfavorable conditions may result in conversion and complications. Information about these conditions may help in planning the laparoscopic approach or in proceeding directly to open cholecystectomy. This study was initiated to evaluate perioperative factors associated with conversion and complications of laparoscopic cholecystectomy in acute cholecystitis. Special attention was paid to the duration of complaints until surgery, to the delay on the part of the patient, and to the delay on the part of the physician. METHODS: Between January 1994 and December 1997, we attempted to perform laparoscopic cholecystectomy on 348 patients with acute cholecystitis. All perioperative data were collected on standardized forms. RESULTS: There were 182 cases (52%) of acute uncomplicated cholecystitis, 90 (26%) of gangrenous cholecystitis, 33 of hydrops (9.5%), and 43 of empyema of the gallbladder (12.5%). Seventy six patients (22%) needed conversion to open cholecystectomy and complications occurred in 57 cases. Advanced cholecystitis was associated with significant patient delay (P = 0.01), and it had a significantly higher conversion rate (39%) compared with early cholecystitis (14.5%); (P <0.00001). Conversion rates were also associated with male gender (P = 0.0017), a history of biliary disease (P = 0.0085), and a patient delay of >48 hours (P = 0.028). The total and infectious complication rates were associated with an age older than 60 years (P = 0.023 and 0.007, respectively) and male gender (P = 0.026 and 0.014, respectively). CONCLUSIONS: In acute cholecystitis, patient delay is associated with a high conversion rate. Early timing of laparoscopic cholecystectomy tends to reduce the conversion rate, as well as the total and the infectious complication rates. Male gender, a history of biliary disease, and advanced cholecystitis are associated with conversion. Male and older patients are associated with a high total and infectious complication rates.     

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial

Background: The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy.Methods: Between January 2001 and November 2002, 40 patients with a diagnosis of acute cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 24 h of admission (early group, n = 20) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy, 6 to 12 weeks later (delayed group, n = 20).Results: There was no significant difference in the conversion rates (early, 25% vs delayed, 25%), operating times (early, 104 min vs delayed, 93 min), postoperative analgesia requirements (early, 5.3 days vs delayed, 4.8 days), or postoperative complications (early, 15% vs delayed, 20%). However, the early group had significantly more blood loss (228 vs 114 ml) and shorter hospital stay (4.1 vs 10.1 days).Conclusions: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 to 96 h of the onset of symptoms.     

Safety and success of early laparoscopic cholecystectomy for acute cholecystitis

Although elective laparoscopic cholecystectomy is today's gold standard for the treatment of symptomatic cholelithiasis, its safety and effectiveness for acute cholecystitis remain controversial. The authors present a retrospective study comparing laparoscopic cholecystectomy in the acute versus the elective setting. A total of 605 patients were treated surgically for gallstone disease between August 1991 and January 1999. A total of 269 patients (44.5%) underwent surgery for acute cholecystitis as soon as possible after diagnosis, and elective cholecystectomy was performed on 336 patients (55.5%) for symptomatic gallstones. Initial open cholecystectomy was performed on 52 (19.3%) of the acute patients and 16 (4.8%) of the elective patients. Laparoscopic cholecystectomy was attempted on 217 of the acute patients (80.7%), with 11 cases (5.1%) converted to open cholecystectomy, and on 320 (95.2%) of the elective patients, with 6 cases (1.9%) converted to open cholecystectomy. The mean (+/-SD) operative time for the acute and elective patients was 105 (+/-38) and 85 (+/-21) minutes, respectively (P < 0.05). There was no perioperative mortality in either laparoscopic group. Surgical complications related to laparoscopic cholecystectomy in the acute and elective groups occurred in six (2.9%) and eight (2.5%) cases, respectively (P = NS). The current study shows that early laparoscopic cholecystectomy for acute cholecystitis is safe and efficient. Low conversion rates can be maintained with strict guidelines for appropriate patient selection, adequate experience, and proper laparoscopic technique.     

Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis

The aim of this prospective comparative study was to determine the feasibility and the efficacy of laparoscopic cholecystectomy for acute cholecystitis in patients older than 75 years of age and to compare the results with those of open cholecystectomy. From January 1992 to December 1999, 139 patients older than 75 years of age underwent cholecystectomy for acute cholecystitis. The two groups of patients with cholecystolithiasis included 50 patients who underwent laparoscopic cholecystectomy (group 1) and 89 patients who underwent open cholecystectomy (group 2). Group 1 consisted of 30 women and 20 men, with a mean age of 81.9 years (range, 75-98). Group 2 consisted of 51 women and 38 men, with a mean age of 81.9 years (range, 75-93). There was no difference in the American Society of Anesthesiologists classification in both groups. The length of the surgery (103.3 vs. 149.7 minutes), postoperative length of stay (7.7 vs. 12.7 days), and inpatient rehabilitation (15 vs. 42 patients) were significantly shorter in group 1 than in group 2. The postoperative morbidity rate was not different between the groups. There was no mortality in group 1, but four patients died in group 2 (P = 0.29). The conversion rate was 32% (n = 16) in group 1. In summary, laparoscopic cholecystectomy in elderly patients with acute cholecystitis is safe and effective. Laparoscopic cholecystectomy in elderly patients restores them to the best possible quality of life with the lowest cost to them physiologically.