急诊和延期腹腔镜手术治疗急性胆囊炎的临床对比分析

摘要

Objective To investigate the safety and feasibility of ELC and DLC for treating acute cholecystitis.Methods The clinical data of 93 cases with acute cholecystitis undergoing acute laparoscopic cholecystectomy(LC)from January 2005 to June 2009 were ana-lyzed retrospectively.All cases were divided into early laparoscopic cholecystectomy(ELC)group and delayed laparoscopic cholecystec-tomy(DLC)group by whether the patients had LC within 72 hours after onset or not.Comparative analysis was made between the 2 groups.The operation time,intraoperative blood loss,conversion to open cholecystectomy,postoperative complications,total hospital stay,hospitalization cost were compared.Results The operative time in ELC and DLC group was (91 ±26.2)min and(104 ±34.7) min,respectively.The intraoperative blood losses in the 2 groups was (64.2 ±32.8)ml and (65.4 ±38.9)ml,respectively.The rates of conversion to laparotomy was 4.4%,8.3%.The rates of postoperative complications were (8.9%,4 /45)and (10.5%,5 /48).The mean hospital stays were (4 ±2.7)d and (8 ±3.9)d,respectively.The hospitalization costs were (4 320 ±1 450)yuan and (6 970 ± 1 572)yuan,respectively.Compared with the DLC group,the total hospital stay significantly reduced and hospitalization cost was signifi-cantly lower in the ELC group(P <0.01).Conclusions ELC and DLC for patients with acute cholecystitis are safe and effective. Compared with the DLC group,the ELC group has advantages of shorter hospital stay and fewer cost,quicker recovery,and better treat-ment outcome and life quality.%目的：探讨急性胆囊炎行急诊（ELC）和延期（DLC）腹腔镜胆囊切除术的安全性和有效性。方法回顾分析2005年1月—2009年6月93例治疗急性胆囊炎患者的临床资料。以起病时间≤72 h 和＞72 h 分为 ELC 组和 DLC 组进行对比分析。比较各组手术时间、术中出血量、中转开腹率、术后并发症发生率、住院时间、治疗费用。结果ELC 组手术时间平均（91±26．2）min，术中出血量（64．2±32．8）mL，中转开腹率4．44％，术后并发症发生率8．9％（4／45），住院时间平均（4±2．7）d，治疗费用平均（4320±1450）元；DLC 组手术时间平均（104±34．7）min，术中出血量平均（65．4±38．9）mL，中转开腹率8．3％，并发症发生率10．5％（5／48），住院时间平均（8±3．9）d，治疗费用平均（6970±1572）元。ELC 组在住院时间和治疗费用方面明显小于 DLC 组（P ＜0．01）。结论ELC 与 DLC 在治疗急性胆囊炎方面均有安全性，ELC 相对 DLC 具有住院时间短，费用较低，恢复较快等特点，在治疗结果和生活质量上更具优势。