急性重症胆囊炎手术时机选择分析
| 作者: |
1施凉潘,
1黄顺涵,
1郑志华,
1刘江睿,
1苏亦斌
1 福建医科大学附属泉州第一医院 普通外科，福建 泉州 362000 |
| 通讯: |
苏亦斌
Email: qzsyb@sina.com |
| DOI: | 10.3978/.2018.02.015 |
摘要
目的：探讨急性重症胆囊炎手术时机的选择。
方法：回顾性分析156例急性重症胆囊炎（ASC）行腹腔镜下胆囊切除术（LC）或行经皮经肝胆囊穿刺引流术（PTGBD）后择期LC患者的临床资料。其中21例行急诊LC，89例于PTGBD后2个月内行LC，46例于PTGBD后2个月以上行LC。比较不同手术时机患者的相关临床指标。
结果：与PTGBD后择期LC患者比较，急诊LC患者的中转开腹例数、住院总费用差异无统计学意义（均P>0.05），但在术中出血量、手术时间、术后住院时间、术后抗生素使用天数、术后疼痛需用镇痛药者、术后并发症发生率均明显增加（均P<0.05）。PTGBD后不同择期LC患者比较，以上指标差异均无统计学意义（均P<0.05）。
结论：对于ASC，不宜早期行急诊LC术，而行PTGBD后2个月内或2个月以上的择期LC术更为合理。
关键词：
胆囊炎，急性；胆囊切除术，腹腔镜；引流术
方法：回顾性分析156例急性重症胆囊炎（ASC）行腹腔镜下胆囊切除术（LC）或行经皮经肝胆囊穿刺引流术（PTGBD）后择期LC患者的临床资料。其中21例行急诊LC，89例于PTGBD后2个月内行LC，46例于PTGBD后2个月以上行LC。比较不同手术时机患者的相关临床指标。
结果：与PTGBD后择期LC患者比较，急诊LC患者的中转开腹例数、住院总费用差异无统计学意义（均P>0.05），但在术中出血量、手术时间、术后住院时间、术后抗生素使用天数、术后疼痛需用镇痛药者、术后并发症发生率均明显增加（均P<0.05）。PTGBD后不同择期LC患者比较，以上指标差异均无统计学意义（均P<0.05）。
结论：对于ASC，不宜早期行急诊LC术，而行PTGBD后2个月内或2个月以上的择期LC术更为合理。
Analysis of surgical timing for acute severe cholecystitis
CorrespondingAuthor:SU Yibin Email: qzsyb@sina.com
Abstract
Objective: To investigate the choice of surgical timing for acute severe cholecystitis (ASC).
Methods: The clinical data of 156 ASC patients undergoing emergency laparoscopic cholecystectomy (LC) or elective LC after percutaneous transhepatic gallbladder drainage (PTGBD) were retrospectively analyzed. Of the patients, 21 cases underwent emergency LC, 89 cases underwent LC within 2 months after PTGBD, and 46 cases underwent LC more than 2 months after PTGBD. The main clinical variables were compared between patients with different surgical timings.
Results: In patients undergoing emergency LC compared with those undergoing elective LC after PTGBD, the number of open conversion and total hospitalization cost showed no statistical difference (both P>0.05), but intraoperative blood loss, operative time, length of postoperative hospital stay, time period for postoperative antibiotic administration, number of cases requiring postoperative analgesics and incidence of postoperative complications were all significantly decreased (all P<0.05). No significant differences were noted in all above variables between patients undergoing elective LC at different times after PTGBD (all P<0.05).
Conclusion: For ASC, performing early emergency LC is inadvisable, while elective LC within or more than 2 months after PTGBD may be more appropriate.
Keywords：
Cholecystitis
Acute; Cholecystectomy
Laparoscopic; Drainage
Methods: The clinical data of 156 ASC patients undergoing emergency laparoscopic cholecystectomy (LC) or elective LC after percutaneous transhepatic gallbladder drainage (PTGBD) were retrospectively analyzed. Of the patients, 21 cases underwent emergency LC, 89 cases underwent LC within 2 months after PTGBD, and 46 cases underwent LC more than 2 months after PTGBD. The main clinical variables were compared between patients with different surgical timings.
Results: In patients undergoing emergency LC compared with those undergoing elective LC after PTGBD, the number of open conversion and total hospitalization cost showed no statistical difference (both P>0.05), but intraoperative blood loss, operative time, length of postoperative hospital stay, time period for postoperative antibiotic administration, number of cases requiring postoperative analgesics and incidence of postoperative complications were all significantly decreased (all P<0.05). No significant differences were noted in all above variables between patients undergoing elective LC at different times after PTGBD (all P<0.05).
Conclusion: For ASC, performing early emergency LC is inadvisable, while elective LC within or more than 2 months after PTGBD may be more appropriate.