急性胆囊炎手术时机选择的对比研究

目的探讨急性期胆囊炎手术的治疗时机。方法 2008年2月～2011年8月103例急性胆囊炎,以发病时间分为3组:发病3 d内为A组42例,3～7 d为B组37例,7～13 d为C组24例。比较3组手术时间、术中出血量、中转开腹率、并发症发生率等。结果 A、B、C组手术时间分别为(25.3±7.0)、(46.5±19.4)、(93.1±21.5)min,两两比较有统计学差异(P=0.000);A、B、C组术中出血量分别为(30.5±12.0)、(72.2±17.0)、(102.4±22.3)ml,两两比较有统计学差异(P=0.000);住院时间A、B、C组分别为(3.2±1.3)、(4.5±1.5)、(6.4±2.7)d,两两比较有统计学差异(P=0.000);A组并发症发生率和中转开腹率均为0,B组和C组并发症发生率、中转开腹率无统计学差异2.7%(1/37)vs.12.5%(3/24),P=0.290;2.7%(1/37)vs.16.7%(4/24),P=0.073]。结论对发病7 d内的病人,严格适应证的选择,积极实施LC是安全的。

Optimal Timing of Operations for Acute Cholecystitis

Objective To discuss the optimal timing for patients with acute cholecystitis to received surgical treatment. Methods Since February 2008 to August 2011, totally 103 patients with acute cholecystitis were admitted to our hospital. The patients were divided into three groups by duration of the disease ： group A ： 〈 3 days, n = 42 ; group B ： 3 - 7 days, n = 37, and group C ：7 -13 days, n = 24. The operation time, intraoperative blood loss, and rates of conversion to open surgery and complications were compared among the three groups. Result Significant difference was detected in the operation time, intraoperative blood loss, and hospital stay between any two of the three groups group A ： （25.3 ± 7.0） min, （30.5 ± 12.0） ml, and （ 3.2 ± 1.3 ） days ; group B ： （46.5 ±19.4） min, （72.2±17.0） ml, and （4.5 ±1.5） days; group C： （93.1 ±21.5） min, （102.4：1：22.3） ml, and （6.4± 2.7 ） days ; all P = 0. 000 ]. In the group A, the rates of conversion to open surgery and complications were both 0, while in the group B and C, the rates were 2.7% （1/37） and 2.7% （1/37） vs. 12.5% （3/24） and 16.7% （4/24） （P=0.290 and 0.073）. Conclusion For patients with acute cholecystitis, with restrict surgical indications, LC is safe within 7 days after onset.