腹腔镜胆囊切除术最佳手术时机及中转开腹的影响因素分析

目的 探讨腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的最佳手术时机及中转开腹的影响因素.方法 回顾性分析行腹腔镜胆囊切除术治疗的急性结石性胆囊炎患者资料,依据发病后手术时间分为A组(<48h)、B组(48~72h)、C组(>72h)、D组(控制感染后择期手术),分析各组手术时间、出血量、中转开腹率、术后引流量、术后排气时间、术后住院时间及并发症发生情况,并分析中转开腹的影响因素.结果 各组患者术后并发症比较差异无统计学意义(χ2=1.14,P>0.05);手术时间、出血量、中转开腹率、术后引流量、术后排气及住院时间等方面比较差异具有统计学意义(P<0.05);胆囊肿大、体温≥38℃、右上腹肌紧张、白细胞>15×109/L、胆囊颈部结石嵌顿、胆囊壁厚度≥6mm与中转开腹率相关(P<0.05);胆囊颈部结石嵌顿、白细胞计数、胆囊壁厚度及右上腹肌紧张是腹腔镜胆囊切术中转开腹的独立危险因素.结论 急性结石性胆囊炎发作后48h是较为理想的腹腔镜手术时机,术前应考虑胆囊颈部结石嵌顿、白细胞计数等影响中转开腹的独立危险因素.

Timing of Laparoscopic Cholecystectomy and Influencing Factors of Conversion to Laparotomy

Objective To investigate the timing of laparoscopic cholecystectomy(LC) for acute calculous cholecystitis and influencing factors of conversion to laparotomy.Method A retrospective analysis of patients with acute calculus cholecystitis data was made.According to operation time after the onset,the patients who underwent laparoscopic cholecystectomy were divided into group A (<48h),group B (48~72h),group C (>72h),and group D (selective surgery after the infection control).The operation time,the blood loss,rate of conversion to laparotomy,postoperative drainage,postoperative exhaust time,postoperative hospital stay and complications were observed and influencing factors of the conversion to laparotomy were analyzed.Results There was no significant difference in the postoperative complications among the different groups(χ2=1.14,P>0.05);differences in the operative time,blood loss,the rate of conversion to laparotomy,postoperative drainage,postoperative discharge and hospital stay were significantly different (P<0.05);the gallbladder enlargement,body temperature≥38℃,right upper quadrant abdominal muscle tension,WBC>15×109/L,gallbladder neck incarcerated stones and gallbladder wall thickness ≥6 mm were correlated with the rate of conversion to laparotomy (P<0.05);Gallbladder neck incarcerated stones,white blood cell count,right upper quadrant gallbladder wall thickness and muscle tension were considered an independent risk factor for the laparoscopic conversion to laparotomy,respectively.Conclusion Forty-eight hours after acute cholecystitis attack should be an ideal time for laparoscopic surgery,and the gallbladder neck calculi incarcerated,leukocyte count and other independent risk factors for the laparoscopic conversion to laparotomy should be considered before surgery.