腹腔镜胆囊切除术治疗急性结石性胆囊炎的手术时机

目的探讨腹腔镜胆囊切除术（｜aparoscopiccholecystectomy，LC）治疗急性结石性胆囊炎的手术时机。方法对南京明基医院2008年5月～2011年5月75例急性结石性胆囊炎行LC的临床资料进行回顾性分析，比较早期组（胆囊炎发作≤72h）与延期组（胆囊炎发作〉72h）手术时间、术中出血量、术后住院时间和近期并发症发生率。结果早期组手术时间（92．4±23．1）min，明显短于延期组（122．0±31．8）rain（t=-4．564，P=0．000）；术中出血量中位数20ml（10-100m1），明显少于延期组中位出血量40ml（10～200m1）（Z=-2．557，P=0．011）；术后住院时间（4．5±1．5）d，明显短于延期组（5．6±2．8）d（t=-2．122，P=0．037）；早期组近期并发症发生率2．6％（1／38），与延期组12．1％（4／33）无统计学差异（，=1．264，P：0．261）。结论急性结石性胆囊炎病人急诊行Lc最好在发病72h内进行，并把握好中转开腹手术的指征。

Operation Timing of Laparoscopic Cholecystectomy in the Treatment of Acute Calculous Cholecystitis

Objective To explore the operative timing of laparoscopic cholecystectomy （LC） for acute calculous cholecystitis. Methods Clinical data of 75 patients with acute cholecystitis combined with gallstone undergoing LC from May 2008 to May 2011 was retrospectively analyzed. The operative time, intraoperative blood loss, intraoperative and postoperative complications, and postoperative length of stay were compared between early-stage patients （course of the disease 〉 72 h） and late- stage patients （course of the disease 〉 72 h）. Results As compared with the late-stage patients, the early-stage group had shorter operative time （92.4＋23.1） min vs. （122.0＋31.8） min, t = -4.564, P=0.000], less intraoperative blood loss 20 （10- 100） mlvs. 40 （10-200） ml, Z= -2.557, P=0.011], and less postoperative length of stay （4.5 ＋1.5） dvs. （5.6 ＋2.8） d, t = - 2. 122, P = 0. 037 ]. Intraoperative and postoperative complications were not significantly different between the two groups 2.6% （1/38） vs. 12. 1% （4/33）, X2 = 1. 264, P = 0. 261 1. Conclusions LC is safe and effective for patients with acute calculous cholecystitis, particularly appropriate in those whose course of the disease equal to and less than 72 h. Conversion to open surgery is necessary when LC is difficult.