急性胆囊炎腹腔镜胆囊切除术适应证的再认识(附601例报告)

目的:探讨急性胆囊炎腹腔镜胆囊切除术(LC)的适应证。方法:将601例患者按病史分为<72h组(248例)、4～7d组(275例)、>8d组(78例),统计每组的临床特征和治疗情况。结果:<72h组临床特征最轻,中转开腹胆囊切除术(OC)<72h组6例(2.4％),4-7d组14例(5％),>8d组4例(5.1％)。结论:(1)急性胆囊炎尽早LC成功率较高;(2)病史>72h,WBC不超过15.0×109/L,体温不超过37.5℃,局部腹膜炎较轻,已进行正规消炎治疗仍为LC适应证;(3)中转OC要视胆囊炎部位、程度、结石梗阻的位置和胆囊管长短而定。

Recognition on indication of laparoscopic cholecytomy (LC) of acute cholecystitis: with a report of 601 cases

Objective:To inquire into the indications of LC of acute cholecystitis.Method:601 patients were divided into three groups according to case history: <72h group(248 cases) ,4-7d group(275 cases), >8d group(78 cases) .The clinical characteristics and treatment of each group were statisticed.Result: It was the lightest in clinic characteristic in < 72h group, the number of cases changing into open cholecytomy (OC) in the three groups was 6 (2.4% ), 14 (5% ) and 4 (5.1%) respectively. Conclusion: (1) The earlier LC is taken, the higher successful rate is got. (2) Case history didn't exceed 72h,WBC <15.0×109/L,T< 37.51 ,and the lighter local periotonitis are all indications of LC. (3) Changing the operation into OC accorded to the position of cholecystitis, obstructing and the length of gallbladder tube.