实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2015年
8期
37-39,45
,共4页
陈小菁%胡晓晴%韦宇峰%郑志祥
陳小菁%鬍曉晴%韋宇峰%鄭誌祥
진소정%호효청%위우봉%정지상
结石嵌顿%急性胆囊炎%腹腔镜胆囊切除术%手术时机
結石嵌頓%急性膽囊炎%腹腔鏡膽囊切除術%手術時機
결석감돈%급성담낭염%복강경담낭절제술%수술시궤
calculus incarceration%acute cholecystitis%laparoscopic cholecystectomy%operating timing
目的：探讨急诊腹腔镜胆囊切除术（LC）治疗急性结石嵌顿性胆囊炎的效果和手术时机的选择。方法回顾性分析160例胆囊颈部结石嵌顿所致急性胆囊炎患者行 LC的临床资料，按发病到手术时间将其分为＜48 h组（n＝68）、48～72 h组（n＝33）和＞72 h组（n＝59）。比较3组患者的手术时间、术中出血、术后住院时间、术后并发症。结果3组患者均无胆管损伤、无手术死亡、无中转病例；＜48 h组均顺利完成手术，48～72 h组1例、＞72 h组2例行胆囊大部切除。＜48 h 组手术时间、术中出血量、住院时间均明显低于48～72 h 组、＞72 h 组（P＜0．05）。＜48 h组穿刺口感染率明显低于48～72 h组、＞72 h组（P＜0．05）。3组术后胆漏发生率比较差异无统计学意义（P＞0．05）。结论急性结石嵌顿性胆囊炎一旦诊断明确，无手术禁忌证者，应尽可能在发病48 h以内行LC术。这样可以尽早缓解患者痛苦，降低手术难度，还能缩短手术和住院时间，减少手术并发症。
目的：探討急診腹腔鏡膽囊切除術（LC）治療急性結石嵌頓性膽囊炎的效果和手術時機的選擇。方法迴顧性分析160例膽囊頸部結石嵌頓所緻急性膽囊炎患者行 LC的臨床資料，按髮病到手術時間將其分為＜48 h組（n＝68）、48～72 h組（n＝33）和＞72 h組（n＝59）。比較3組患者的手術時間、術中齣血、術後住院時間、術後併髮癥。結果3組患者均無膽管損傷、無手術死亡、無中轉病例；＜48 h組均順利完成手術，48～72 h組1例、＞72 h組2例行膽囊大部切除。＜48 h 組手術時間、術中齣血量、住院時間均明顯低于48～72 h 組、＞72 h 組（P＜0．05）。＜48 h組穿刺口感染率明顯低于48～72 h組、＞72 h組（P＜0．05）。3組術後膽漏髮生率比較差異無統計學意義（P＞0．05）。結論急性結石嵌頓性膽囊炎一旦診斷明確，無手術禁忌證者，應儘可能在髮病48 h以內行LC術。這樣可以儘早緩解患者痛苦，降低手術難度，還能縮短手術和住院時間，減少手術併髮癥。
목적：탐토급진복강경담낭절제술（LC）치료급성결석감돈성담낭염적효과화수술시궤적선택。방법회고성분석160례담낭경부결석감돈소치급성담낭염환자행 LC적림상자료，안발병도수술시간장기분위＜48 h조（n＝68）、48～72 h조（n＝33）화＞72 h조（n＝59）。비교3조환자적수술시간、술중출혈、술후주원시간、술후병발증。결과3조환자균무담관손상、무수술사망、무중전병례；＜48 h조균순리완성수술，48～72 h조1례、＞72 h조2례행담낭대부절제。＜48 h 조수술시간、술중출혈량、주원시간균명현저우48～72 h 조、＞72 h 조（P＜0．05）。＜48 h조천자구감염솔명현저우48～72 h조、＞72 h조（P＜0．05）。3조술후담루발생솔비교차이무통계학의의（P＞0．05）。결론급성결석감돈성담낭염일단진단명학，무수술금기증자，응진가능재발병48 h이내행LC술。저양가이진조완해환자통고，강저수술난도，환능축단수술화주원시간，감소수술병발증。
Objective To investigate the effect of laparoscopic cholecystectomy(LC)on acute calculous incarcerated cholecystitis(ACIC)and the choice of operating timing.Methods Clinical data of 160 patients who underwent LC for acute cholecystitis induced by gallstones incarcerated in the neck of gallbladder were analyzed retrospectively.According to the time from onset to oper-ation,these patients were divided into three groups:<48 h group(n=68),48-72 h group(n=33) and >72 h group(n=59).The operation time,intraoperative bleeding,postoperative hospital stay and postoperative complications were compared among the three groups.Results No bile duct in-j ury and death occurred in all patients.No patients were converted to open surgery.Patients in<48 h group successfully completed the operation.One patient in 48-72 h group and two patients in >72 h group underwent subtotal cholecystectomy.Compared with 48-72 h group and >72 h group,the operation time,intraoperative bleeding,postoperative hospital stay and incidence of puncture infection significantly decreased in <48 h group(P<0.05).There were no significant differences in the incidence of bile leakage among the three groups(P>0.05).Conclusion Once ACIC is confirmed,LC should be performed within 48 hours after onset as far as possible in pa-tients with no contraindications to operation.The timely operation can alleviate the suffering of patients,reduce the difficulty of operation,shorten the operation time and hospital stay,and de-creased the surgical complications.
