急性胆囊炎腹腔镜手术时机的临床探讨

发布时间：2018-05-29 14:23

本文选题：腹腔镜 + 急性胆囊炎　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨临床急性期胆囊炎(Acute cholecystitis)行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术治疗时机。[方法]回顾性分析2014年1月至2016年12月昆明医科大学第一附属医院肝胆外科收治的171例不同时期急性胆囊炎患者行LC术的临床资料。根据病人疾病病程进展将所有病例分为4组:发病3d内手术为A组(42例),4～7 d内手术为B组(44例),8～14d内手术为C组(37例),保守治疗3周后择期手术为D组(48例)。通过统计学方法分析比较4组手术持续时间、术中出血量、中转开腹率、并发症发生率等差异,探讨急性胆囊炎手术治疗的最佳时机。[结果]手术患者中成功行LC 150例,中转开腹21例,中转率12.3%,无死亡病例。A组中转开腹率(7.1%)、组B中转开腹率(11.4%)显著低于C组中转开腹率(32.4%);组B中转开腹率与组A无统计学差异;组A、组B中转开腹率与组D中转开腹率(10.4%)无统计学差异;组C中转开腹率与其余3组间两两比较有统计学差异。组A、组B和组C三组间手术时间逐渐延长,组D手术时间短于组C,与组A、组B相比无统计学意义;组A组B、组C出血量逐渐增多,组D出血量多于组A而与组B无明显统计学差异。组A、组B和组C住院时间逐渐延长,组D与组A、组B相比住院时间无统计学差异,组C住院时间长于组D。组A、组B、组C住院费用逐渐增多。四组间并发症发生率没有统计学差异。[结论]从本组资料来看,7天内手术并没有增加中转开腹率,保守治疗后择期手术并没有相对减少手术时间、术中出血量及住院恢复时间。对于病程7天内的患者在排除手术禁忌症的情况下应尽早手术治疗,早期腹腔镜下胆囊切除术能相应减少手术时间、术中出血量、住院恢复时间及费用。而对与病程超过7天的病人,可根据临床实际情况考虑是否先暂行保守治疗,待症状缓解度过炎症期后再择期行LC术。
[Abstract]:[objective] to investigate the opportunity of laparoscopic cholecystectomy (LC) for acute cholecystitis in patients with acute cholecystitis. [methods] the clinical data of 171 patients with acute cholecystitis treated in Department of Hepatobiliary surgery, first affiliated Hospital of Kunming Medical University from January 2014 to December 2016 were analyzed retrospectively. According to the disease progression, all the patients were divided into 4 groups: 42 patients in group A were operated within 4 days after the onset of the disease: 44 patients in group B were operated within 4 days, 37 patients in group C were operated within 14 days after conservative treatment, 48 patients in group D received elective operation after 3 weeks of conservative treatment. The operative duration, intraoperative blood loss, conversion rate and complication rate were analyzed and compared among the four groups by statistical method, and the optimal time for surgical treatment of acute cholecystitis was discussed. [results] 150 cases of LC were successfully performed, 21 cases were transferred to laparotomy, and the conversion rate was 12.3%. The rate of conversion to laparotomy was 7.1g in group A and 11.4m in group B), which was significantly lower than that in group C (32.4%), but there was no significant difference between group B and group A. There was no significant difference between group A, group B and group D (10.4%), but the rate of conversion from group C to laparotomy was significantly different from that of the other three groups. The operative time between group A, group B and group C was prolonged gradually, the operative time of group D was shorter than that of group C, and there was no significant difference between group A and group B. The amount of D bleeding in group D was more than that in group A, but there was no significant difference between group B and group D. The hospitalization time of group A, group B and group C was prolonged gradually. Group D and group A, group B had no significant difference in hospitalization time, group C was longer than group D. The hospitalization expenses of group A, group B and group C increased gradually. There was no significant difference in the incidence of complications among the four groups. [conclusion] according to the data of this group, the rate of conversion to laparotomy has not been increased in 7 days. The selective operation after conservative treatment has not reduced the operative time, the amount of intraoperative bleeding and the time of hospital recovery. Early laparoscopic cholecystectomy could reduce the operation time, blood loss, hospital recovery time and cost. For the patients with more than 7 days course of disease, we can consider whether to take temporary conservative treatment according to the actual clinical conditions, and then to choose LC after the remission of symptoms after the inflammatory period.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.41

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