急性胆囊炎腹腔镜胆囊切除术与开腹手术的对比研究

目的探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）治疗急性胆囊炎的价值。方法回顾性分析2008年8月-2011年8月因急性胆囊炎行腹腔镜（LC组，n=67）或开腹（OC组，n=58）胆囊切除术的临床资料，比较2组手术时间、出血量、肠蠕动恢复时间、住院时间、镇痛剂使用率、并发症情况。结果LC组64例手术成功，3例中转开腹（2例因Calot三角粘连严重分离困难，1例为胆囊床出血较多镜下止血困难），术后切口感染1例（1．6％），胆漏1例（1．6％），并发症发生率3．1％（2／64）。OC组切口感染4例（6．9％），腹腔残余脓肿1例（1．7％），胆漏2例（3．4％），粘连性肠梗阻2例（3．4％），并发症发生率15．5％（9／58），显著高于LC组（χ2=5．696，P=0．017）。与OC组相比，LC组手术时间短[（42．6±12．3）min vs．（63．8±11．6）min，t=-9．767，P=0．000]，术中出血量少[（47．8±11．5）ml vs．（76．3±14．2）ml，t=-12．231，P=0．000]，肠蠕动恢复早[（24．2±3．7）hvs．（43．7±8．6）h，t=-16．535，P=0．000]，术后住院时间短[（4．6±2．2）d vs．（9．1±3．4）d，t=-8．758，P=0．000]，术后镇痛剂使用率低[20．3％（13／64）vs．48．3％（28／58），χ2=10．663，P=0．001]。结论与OC比较，LC治疗急性胆囊炎具有创伤小、恢复快、住院时间短、并发症少等优点，值得推广。

Comparative Study on Laparoscopic and Open Cholecystectomy for Acute Cholecystitis

Objective To investigate the value of laparoscopic cholecystectomy （LC） for acute cholecystitis. Methods The clinical data of 67 patients undergoing LC and 58 patients undergoing open cholecystectomy （OC） from August 2008 to August 2011 were retrospectively reviewed. The operation time, blood loss, intestinal peristalsis recovery time, hospital stay, analgesic administration and complications were compared between the two groups. Results In LC group, 64 cases went through the surgery successfully, and 3 cases were converted to laparotomy including 2 cases of severe adhesions of Calot Triangle and difficult separation and 1 ease of hemostasis difficulty under laparoseope due to massive gallbladder bed bleeding. There were 1 ease of postoperative incision infection （1.6%）., and 1 case of biliary leakage （1.6%）. The incidence of complication was 3.1% （2/64）. In OC group, there were 4 cases of incision infection （6.9%）, 1 case of abdominal residual abscess （ 1.7% ）, 2 cases of biliary leakage （3.4%） and 2 cases of adhesive intestinal obstruction （3.4%）. The incidence of complication of OC group was 15.5 % （9/58）, significantly higher than that of LC group （χ2 =5. 696, P =0. 017）. Compared with OC group, LC group had shorter operative time [ （42.6 ± 12.3） min vs. （63.8±11.6） rain, t = -9.767, P=0.000],less blood loss [（47.8 ±11.5） ml vs. （76.3 ±14.2） ml, t = - 12.231, P = 0. 000 ], shorter intestinal peristalsis recovery time [ （ 24.2 ± 3.7 ） h vs. （43.7 ± 8.6 ） h, t = - 16. 535, P = 0. 000 ], shorter postoperative hospital stay [ （4.6 ± 2.2 ） d vs. （ 9.1 ± 3.4 ） d, t = - 8. 758, P = 0. 000 ] and lower administration ratio of postoperative analgesic [20.3% （13/64） vs. 48.3% （28/58） ,χ2 =10.663, P=0.001]. Conclusion Compared with OC, LC has smaller trauma, quicker recovery, shorter hospital stay, fewer complications for the treatment of acute cholecystitis.