卢钦荣 卢裕 刘志浩

[摘要] 目的 探討急诊行腹腔镜下胆囊切除术（LC）治疗急性结石性胆囊炎患者的临床安全性及预后效果。 方法 统计分析我院于2016年10月～2019年4月急诊收入的108例急性结石性胆囊炎患者为研究对象，对其临床资料进行回顾性分析，根据手术时机分为急诊组（12 h内行急诊LC手术，48例）和延期组（12 h～1周内行LC手术，60例）。比较两组患者的术中情况、手术并发症发生情况和术后恢复情况指标。 结果 急诊组手术时间、胃肠道恢复时间、术后疼痛时间、住院总时间均显著短于延期组，术中出血量显著少于延期组，住院费用显著少于延期组，比较差异均存在统计学意义（P<0.05），两组胆囊壁厚度、手术切口、拔除引流管时间、术后住院时间和中转开腹率比较差异均无统计学意义（P>0.05）。两组患者手术并发症发生率比较差异无统计学意义（P>0.05）。 结论 对于急性结石性胆囊炎患者，急诊行腹腔镜下胆囊切除术，能早期切除病灶，清除结石及感染性胆汁，迅速控制炎症，只要把握好手术技巧，急诊LC相比保守治疗后延期手术相比的手术创伤更小，出血及并发症发生率更低，术后恢复更快，还可减少患者住院时间和住院费用，是一种切实可行的手术方式。

[关键词] 急诊;急性结石性胆囊炎;腹腔镜胆囊切除术;安全性;预后

[中图分类号] R657.41          [文献标识码] B          [文章编号] 1673-9701（2020）17-0048-04

Clinical safety and prognosis evaluation of emergency laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis

LU Qinrong   LU Yu   LIU Zhihao

Department of Oncology， Meizhou Traditional Chinese Medicine Hospital in Guangdong Province， Meizhou   514071， China

[Abstract] Objective To investigate the clinical safety and prognosis of laparoscopic cholecystectomy（LC） in the treatment of acute calculous cholecystitis. Methods A total of 108 patients with acute calculous cholecystitis admitted to the Emergency Department in our hospital from October 2016 to April 2019 were enrolled in the study. The clinical data were retrospectively analyzed. The patients were divided into emergency group（emergency LC surgery within 12 hours， 48 cases） and delayed group（LC surgery within 12 h-1 week， 60 cases） according to the timing of surgery. The intraoperative conditions， surgical complications， and postoperative recovery were compared between the two groups. Results The operation time， gastrointestinal recovery time， postoperative pain time， and total hospitalization time in the emergency group were significantly shorter than those in the delayed group. The intraoperative blood loss in the emergency group was significantly less than that in the delayed group. The hospitalization cost in the emergency group was significantly less than that of the delayed group. The difference between two groups was statistically significant（P<0.05）. There was no significant difference between the two groups in gallbladder wall thickness， surgical incision， drainage tube removal time， postoperative hospital stay and conversion to laparotomy rate（P>0.05）. There was no significant difference in the incidence of surgical complications between the two groups（P>0.05）. Conclusion For patients with acute calculous cholecystitis， emergency laparoscopic cholecystectomy can remove the lesion early， remove stones and infectious bile， and quickly control inflammation. As long as the surgical technique is mastered， the emergency LC has smaller surgical trauma compared with delayed group. The incidence of bleeding and complications is lower， and postoperative recovery is faster. It can also reduce the hospitalization time and hospitalization cost. It is a practical surgical method.

[Key words] Emergency; Acute calculous cholecystitis; Laparoscopic cholecystectomy; Safety; Prognosis

急性结石性胆囊炎作为一种常见急腹症，中老年人多发，随着我国人民饮食习惯及结构的改变，其发病率呈逐年增长趋势。急性结石性胆囊炎具有发病急、进展快、症状重、发病机制复杂等特点，多数是由于结石在胆囊颈内嵌顿阻塞导致的急性炎症，严重的会早期化脓;如果早期不采取有效治疗，炎症存在扩散至周围组织或导致胆囊化脓、穿孔的可能，严重时甚至可出现感染性休克等危及生命情况[1-2]。长期……