急性结石性胆囊炎腹腔镜胆囊切除术时机选择及中转开腹的影响因素研究

目的 探讨采用腹腔镜胆囊切除术对急性结石性胆囊炎患者治疗的最佳时机选择及影响中转开腹的因素.方法 回顾性分析2009年3月～2013年5月来我院进行治疗的288例急性结石性胆囊炎患者的临床资料,按照患者从症状发作到接受手术的时间进行分组,Ⅰ组93例患病时间在48 h内,Ⅱ组86例患病介于48～72 h之间,Ⅲ组66例患病超过72 h,Ⅳ组43例患者择期手术.结果 四组术后并发症发生率不具有显著性差异（P＞0.05）.Ⅱ组、Ⅲ组、Ⅳ组中转开腹率高于Ⅰ组,手术时间长于Ⅰ组（P＜0.05）,Ⅱ组及Ⅳ组中转开腹率低于Ⅲ组,手术时间短于Ⅲ组（P＜0.05）.体温≥38℃患者、有胆囊肿大、右上腹肌紧张、白细胞计数≥15.0×109/L、胆囊壁厚度≥6 mm、有胆囊颈部结石嵌顿及手术时机＞48 h的患者具有较高的中转开腹率（P＜0.05）.白细胞计数及手术时机为腹腔镜胆囊切除术中转开腹的影响因素（P＜0.05）.结论 症状发作后48 h内为急性结石性胆囊炎患者采用腹腔镜胆囊切除术的最佳时机,影响中转开腹的两个独立危险因素为白细胞计数及手术时机的选择.

The research of opportunity selection and the influence factors of conver-sion to open laparotomy in acute calculous cholecystitis laparoscopic cholecystectomy

Objective To investigate the best chance of selection and factors that affect conversion to open laparotomy of laparoscopic cholecystectomy for acute calculous cholecystitis patients. Methods The clinical data of 288 cases with acute calculous cholecystitis selected from March 2009 to May 2013 in our hospital were retrospective analyzed, all subjects were performed laparoscopic cholecystectomy. They were grouped according to the time from symptom onset to surgery, there were 93 cases in I group and the set time within 48 h, there were 86 cases in. H group and the set time 48 to 72 h, there were 66 cases in llI group and the set time more than 72 h, there were 43 cases in the IV group and they were underwent elective surgery. Results There were no significant difference in the postoperative complica- tion rate among four groups （P〉0.05）. Conversion to open laparotomy rate of I1 group, m group, IV group were higher than in group I, operation time were longer than group I （P〈0.05）, conversion to open laparotomy rate of group II and IV group were lower than the group 11I, and conversion to open laparotomy surgery time were shorter than group m （P〈O.05）. Temperature I〉 38~C, gallbladder enlargement, or upper abdominal muscle tension, white blood cell count acuity ~ 15.0x109/L, the gallbladder wall thickness ~6 mm, with calculus incarcerated gall bladder neck and surgery time 〉 48 h patients had higher conversion to open laparotomy rate （P〈0.05）. White blood cell count and operation time were the influence factors of conversion to open laparotomy laparoscopic cholecystectomy （P〈0.05）. Conclusion Within 48 h after onset of symptoms by laparoscopic cholecystectomy is the best chance of acute calculous cholecystitis patients, white blood cell count and the timing of surgery are two independent risk factors of affect the conversion to open laparotomy.