急性结石性胆囊炎手术时机的选择及预后分析（附120例病例分析）.docVIP

急性结石性胆囊炎手术时机的选择 王昌青（安徽省铜陵市人民医院普外二科） 摘要 目的：探讨急性结石性胆囊炎的手术时机的选择。 方法：120例急性结石性胆囊炎分为急诊手术组(组I,n=40)、延期手术组(组II,n=40)、择期手术组(组III,n=40)，对并发症,治疗结果进行统计学分析。 结果：急诊手术组和择期手术组的术后并发症发生率均低于延期手术组, 择期手术组治愈率高, ( P 0. 05),且LC术式明显高于前两组(P 0. 05)。 结论：急性结石性胆囊炎急诊早期手术和择期手术优于延期。急性胆囊炎发病后72h内均可进行安全的胆囊切除手术。病程超过一周者宜采取保守治疗,6～8 周后行择期手术。 关键词：急性结石性胆囊炎 Timing of cholecystectomy for acute gallstone cholecystitis Wang Chang Qing Department of the second of General Surgery ,People’s Hospital of Tongling , AnHui Abstract : Objective: To discuss the appropriate time of cholecystectomy for acute gallstone cholecystitis. Methods: 120 cases of acute gallstone cholecystitis were divided into 3 groups , emergenent cholecystectomy group(I), ,40 patients ,early surgery undertaken within 72 hours following the onset of acute gallstone cholecystitis ; delayed cholecystectomy group( Ⅱ) ,40 cases , intervention within 7 days to 2 weeks , and selective cholecystectomy group( Ⅲ) ,40 cases, surgery done within one month to two months. Statistic analysis was made in terms of incidences of postoperative complication and therapeutic result. Result: the incidence of postoperative complication was significantly lower in groupⅠand III in group II. therapeutic result was significantly better in group III than in group I and group II ( P 0. 05) . The mathod of laparoscopic cholecystectomy used in group III was significantly higher than in group I and group II( P 0. 05). Conclusion : emergenent cholecystectomy and delayed cholecystectomy is superior to all others for the patients of acute gallstone cholecystitis. Acute gallstone cholecystectomy can be safely undertaken in different intervals within 72 hours following the onset of acute gallstone cholecystitis. When the course of acute cholecystitis was over a week ,drug therapy can be suggested. 1.资料和方法 1.1临床资料 随机选取2001~2007年本院因急性结石性胆囊炎行急诊手术，保守治疗7~14天后早期手术，保守治疗好转1~2月后择期手术的病人各40例，共120例，其中男性36例，女性84例，年龄22~74岁平均年龄53.3岁。 1.2方法 急诊手术组：入院后保守治疗24~48小时，症状和体征不能缓解或加重，积极完善术前准备后，在72