急性胆囊炎术后住院时间延长因素探析.doc

急性胆囊炎术后住院时间延长因素探析 　 作者：宋 新，花 瞻，周 雷，黄林平，贾振庚 【摘要】 目的 探讨急性胆囊炎行胆囊切除术住院时间延长的相关因素。方法 选择2002年1月～2004年1月间患急性胆囊炎，并急诊行开腹胆囊切除术的患者139例，据术后住院时间分为短期住院组（术后住院≤7天）和长期住院组（术后住院＞7天），并以此与年龄、性别、最高体温、白细胞计数、既往上腹部手术史、部分生化指标（TBIL、ALT、AST、ALP、GGT和AMY）、胆囊壁厚度（≥或＜3.5mm）、有无胆总管结石、手术时间、出血量以及术后并发症等临床参数探讨影响术后住院时间的危险因素。结果 单因素分析年龄、上腹部既往手术史、体温、胆总管结石、手术时间和术后并发症与术后住院时间延长有关；多因素分析上腹部手术史、体温和年龄是造成术后住院时间延长的危险因素。结论 年龄、体温和上腹部既往手术史是导致急性胆囊炎行胆囊切除术术后住院时间延长最重要的危险因素。这样的患者术前进行必要的分析和准备并确定最佳的治疗程序对提高治疗效果有重要的意义。 【关键词】 急性胆囊炎；胆囊切除术；术后住院时间 【Abstract】 Objective To explore the risk factors of duration of hospitalization of cholecystectomy in patients with acute cholecystitis.Methods 139 patients admitted with acute cholecystitis were selected for a prospective study to analyze the risks of emergency cholecystectomy，from 2002 to 2004.Comparative evaluation was carried out regarding age，gender，top temperature，WBC count，operation history of midsection，some lab test parameters(TBIL，ALT，AST，ALP，GGT and AMY），thickness of gallbladder wall(≥或＜3.5mm)，common bile duct calculi，operation duration，amount of bleeding and postoperative complications between short term group(hospitalization duration of postoperation ≤7 days)and long term group(hospitalization duration of postoperation ＞7days).Results There was a significant difference between short term group and long term group for age，top temperature，operation history of midsection，common bile duct calculi and operation duration by univariate analysis.Age，top temperature and operation history of midsection were correlated with longer duration of hospitalization by COX regression analysis.Conclusion Age，top temperature and operation history of midsection were the most important risk factors that increase duration of hospitalization of cholecystectomy in patients with acute cholecystitis.It is important that essential preoperative management and establishing the best treatment procedure to improve outcome. 【Key words】 cholecystectomy；acute cholecystitis；postoperation hospitalization dur