CAJ | 학술논문

目的探讨急性胆囊炎腹腔镜手术时机的选择及中转开腹的影响因素.方法 160例行腹腔镜手术的急性胆囊炎患者,按出现症状距手术时间分为四组:24 h以内手术为A组(56例)、24～48 h手术为B组(42例)、49 ～ 72 h手术为C组(40例)、72 h以后手术为D组(22例),比较各组手术时间、中转开腹、住院时间及住院费用等,并分析影响腹腔镜手术中转开腹的相关因素.结果 D组中转开腹率[ 59.09％( 13/22)]明显高于A组[19.64％( 11/56)](P＜0.01).A组手术时间最短,D组手术时间最长.D组住院时间明显长于其他各组(P＜0.05).各组住院费用比较差异无统计学意义(P＞0.05).单因素分析结果显示,白细胞计数、体温、手术时机、胆囊颈部结石嵌顿是影响中转开腹的危险因素(P＜0.05).多因素回归分析结果显示,白细胞计数和手术时机是中转开腹的独立危险因素(P＜0.05).结论急性胆囊炎腹腔镜手术中转开腹与白细胞计数、体温、手术时机、胆囊颈部结石嵌顿等因素有关,白细胞计数和手术时机是其独立危险因素.腹腔镜手术的最佳时机为发病后72h内,并且白细胞计数＜15×1099/L.
목적 탐토급성담낭염복강경수술시궤적선택급중전개복적영향인소.방법 160례행복강경수술적급성담낭염환자,안출현증상거수술시간분위사조:24 h이내수술위A조(56례)、24～48 h수술위B조(42례)、49 ～ 72 h수술위C조(40례)、72 h이후수술위D조(22례),비교각조수술시간、중전개복、주원시간급주원비용등,병분석영향복강경수술중전개복적상관인소.결과 D조중전개복솔[ 59.09％( 13/22)]명현고우A조[19.64％( 11/56)](P＜0.01).A조수술시간최단,D조수술시간최장.D조주원시간명현장우기타각조(P＜0.05).각조주원비용비교차이무통계학의의(P＞0.05).단인소분석결과현시,백세포계수、체온、수술시궤、담낭경부결석감돈시영향중전개복적위험인소(P＜0.05).다인소회귀분석결과현시,백세포계수화수술시궤시중전개복적독립위험인소(P＜0.05).결론 급성담낭염복강경수술중전개복여백세포계수、체온、수술시궤、담낭경부결석감돈등인소유관,백세포계수화수술시궤시기독립위험인소.복강경수술적최가시궤위발병후72h내,병차백세포계수＜15×1099/L.
Objective To explore the influencing factors and timing of acute cholecystitis laparoscopic surgery.Methods One hundred and sixty acute cholecystitis patients treated with laparoscopic surgery were divided into group A (56 cases,performed treatment within 24 h),group B (42 cases,performed treatment at 24 -48 h),group C ( 40 cases,performed treatment at 49 -72 h),group D (22 cases,performed treatment after 72 h).The operation time,rate of conversion to laparotomy,length of stay and average costs were compared among four groups and analyzed the impact of laparoscopic surgery conversion to laparotomy.Results The rate of conversion to laparotomy of group D [ 59.09％(13/22) ] was significantly higher than that in group A [ 19.64％(11/56) ] (P ＜ 0.01 ).The operation time of group A was the shortest and group D was the longest.The length of stay of group D was significantly longer than other groups (P ＜ 0.05 ).The costs of the four groups had no significant difference(P ＞ 0.05 ).Single factor analysis showed that white blood cell (WBC) count,body temperature,timing of surgery,gallbladder neck calculi incarceration were correlated with conversion to laparotomy(P ＜ 0.05 ).Multifactor analysis showed that WBC count,timing of surgery were independent risk factors of conversion to laparotomy (P ＜ 0.05 ).Conclusions WBC count,body temperature,timing of surgery,gallbladder neck calculi incarceration are correlated with acute cholecystitis laparoscopic surgery conversion to laparotomy.While WBC count and timing of surgery are independent risk factors.The best time of laparoscopic surgery is within 72 h and WBC count ＜ 15 x 109/L.