腹腔镜胆囊切除术作为急性胆囊炎治疗选择的评价.docVIP

???? 腹腔镜胆囊切除术作为急性胆囊炎治疗?选择的评价 ???? ???? 摘要　目的　对腹腔镜胆囊切除术(LC)作为急性胆囊炎的治疗选择作出评估。方法　采用回顾性调查方法对LC治疗的207例胆囊结石伴急性胆囊炎患者的中转开腹、术后并发症情况及影响中转开腹的一些因素进行研究。结果　本组中转开腹率达32.3%，中转开腹的术后并发症发生率(20.9%)显著高于非中转开腹病例(5.7%)。影响中转开腹的因素有患者的性别，急性胆囊炎的胆囊状况，现病史长短，发病至手术的时间及外周血白细胞计数等。结论　对急性胆囊炎选择LC应慎重，对经判断中转风险较高的病例，不宜选择LC。关键词　急性胆囊炎　　腹腔镜胆囊切除术 Evaluation of laparoscopic cholecystectomy for acutecholecystitis: a method of choice? LAN Zhu, ZHOU Yongbi, WEI Changzheng.Hepatobiliary Surgery Center, Southwest Hospital, Third Military Medical University, Chongqing 400038 Abstract　Objective　Whether laparoscopic cholecystectomy(LC) is a treatment of choice for acute cholecystitis remains debatable. This study was attempted to make an evaluation on the topic. Methods 207 patients treated by LC for gallbladder stone with acute inflammation were retrospectively reviewed with emphasis on incidence of postoperative complication, rate of conversion to open cholecystectomy(OC) and factors influencing the conversion of approach. Results　This series revealed that the rate of conversion to OC attained 32.3%; the incidence of complication reached 20.9%, significantly higher than that after conventional OC( 5.7% ). Pathology of the inflamed gallbladder ; time elapsed from onset ; length of present history ; severity of leucocytosis and even patient’s sex were taken into consideration as probable factors for the conversion . Conclusion　In the case of acute cholecystitis adoption of LC should be scrutinized because LC is likely to be contraindicated in presence of the factors mentioned above.Key words　Acute cholecystitis　Laparoscopic cholecystectomy 　　对不伴急性胆囊炎的胆囊结石的治疗，选择腹腔镜胆囊切除术(LC)已得到肯定，但对伴急性胆囊炎的胆囊结石的治疗，则报道较少，且结果差异较大［1-5］，为对LC作为急性胆囊炎的治疗选择作出评估，我们对LC治疗的207例胆囊结石伴急性胆囊炎患者作回顾性调查，现报告如下。 资料与方法　　一、一般资料：自1994年5月至1998年7月收治的207例有症状胆囊结石伴急性胆囊炎患者，其中男性83例，女性124例；年龄22～75岁，平均41.5岁。术前检查未发现明显LC手术禁忌证。　　二、方法：对207例急性胆囊炎患者LC中转开腹及术后并发症情况进行回顾性调查，对中转开腹与急性胆囊炎局部炎症状况、患者现病史时间长短、发病至手术时间、外周血白细胞计数、血清总胆红素、年龄与性别等因素的关系进行分析，并分析中转开腹对术后并发症的影响。　　三、统计学处理：除年龄与