急性结石性胆囊炎腹腔镜胆囊切除术中转开腹影响因素分析

目的研究急性结石性胆囊炎腹腔镜胆囊切除术的手术时机及影响中转开腹的相关因素。方法选择219例我院收治的急性结石性胆囊炎并行腹腔镜胆囊切除术患者,按手术时机分为A、B、C、D四组。A组为48 h内手术63例,B组为48~72 h内手术53例,C组为72 h~2周内手术58例,D组为入院后先行抗感染及对症治疗,在发作两周后择期手术45例,收集相关临床资料进行统计学分析。结果 A、D组手术时间、术后腹腔引流量、并发症、中转开腹率较B、C组少(P<0.05),而A、D组手术时间、术后腹腔引流量、并发症比较,差异无统计学意义(P>0.05),A组中转开腹率与D组比较,差异有统计学意义(P<0.05)。体温、右上腹肌紧张、触及胆囊、白细胞计数、B超见胆囊肿大、胆囊壁厚度、胆囊颈部结石嵌顿与中转开腹有关(P<0.05)。手术时机、白细胞计数、胆囊颈部结石嵌顿是急性结石性胆囊炎腹腔镜胆囊切除术中转开腹独立危险因素(OR=2.892、3.168、2.124,P<0.05)。结论急性结石性胆囊炎可尽早进行手术,发作48 h内是腹腔镜手术治疗最佳时机,其次可先行保守治疗后再择期手术治疗,可减少手术风险及并发症,中转开腹受到手术时机选择、血象及结石位置影响,应综合考虑提高腹腔镜手术成功率。

Acute cholecystitis laparoscopic cholecystectomy surgery laparotomy factors

Objective To study acute cholecystitis laparoscopic cholecystectomy timing of surgery and related factors affecting laparotomy, Methods 219 cases admitted to our hospital with acute cholecystitis in patients with laparoscopic cholecystectomy in parallel, according to the timing of surgery were divided into A group of 63 cases of surgery within 48 h, B group of 53 cases of surgery in 48-72 h, C group of 58 cases of surgery in 72 h -2 weeks, D group of 45 cases of surgery in the attack 2 weeks after elective after admission first anti-infective and symptomatic treatment, collectd clinical data for statistical analysis. Results A, D operative time, postoperative abdominal drainage, complications, laparotomy rate were than B, C less （P 〈0.05）, while the A, D operative time, postoperative abdominal drainage, complications, the differences were not statistically significant （P〉 0.05）, A group laparotomy rate and D group, the difference was statistically significant （P 〈0.05）. Body, right upper quadrant muscle tension, touching the gallbladder, white blood cell count, B-gallbladder enlargement, gallbladder wall thickness, impacted stones in the gallbladder neck with laparotomy related （P 〈0.05）. Timing of surgery, white blood cell count, impacted stones in the gallbladder neck acute cholecystitis laparoscopic cholecystectomy surgery laparotomy independent risk factors （OR =2.892, 3.168,2.124, P 〈0.05）. Conclusion Acute cholecystitis surgery as soon as possible, within 48h attack is the best time of laparoscopic surgery, followed by conservative treatment can first before elective surgery can reduce the risks and complications of surgery, timing of surgery by laparotomy, blood and stone location effects, should be considered to improve the success rate of laparoscopic surgery.