本文選題：腹腔鏡 + 急性膽囊炎��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]探討臨床急性期膽囊炎(Acute cholecystitis)行腹腔鏡膽囊切除術(shù)(laparoscopic cholecystectomy,LC)的手術(shù)治療時機。[方法]回顧性分析2014年1月至2016年12月昆明醫(yī)科大學第一附屬醫(yī)院肝膽外科收治的171例不同時期急性膽囊炎患者行LC術(shù)的臨床資料。根據(jù)病人疾病病程進展將所有病例分為4組:發(fā)病3d內(nèi)手術(shù)為A組(42例),4～7 d內(nèi)手術(shù)為B組(44例),8～14d內(nèi)手術(shù)為C組(37例),保守治療3周后擇期手術(shù)為D組(48例)。通過統(tǒng)計學方法分析比較4組手術(shù)持續(xù)時間、術(shù)中出血量、中轉(zhuǎn)開腹率、并發(fā)癥發(fā)生率等差異,探討急性膽囊炎手術(shù)治療的最佳時機。[結(jié)果]手術(shù)患者中成功行LC 150例,中轉(zhuǎn)開腹21例,中轉(zhuǎn)率12.3%,無死亡病例。A組中轉(zhuǎn)開腹率(7.1%)、組B中轉(zhuǎn)開腹率(11.4%)顯著低于C組中轉(zhuǎn)開腹率(32.4%);組B中轉(zhuǎn)開腹率與組A無統(tǒng)計學差異;組A、組B中轉(zhuǎn)開腹率與組D中轉(zhuǎn)開腹率(10.4%)無統(tǒng)計學差異;組C中轉(zhuǎn)開腹率與其余3組間兩兩比較有統(tǒng)計學差異。組A、組B和組C三組間手術(shù)時間逐漸延長,組D手術(shù)時間短于組C,與組A、組B相比無統(tǒng)計學意義;組A組B、組C出血量逐漸增多,組D出血量多于組A而與組B無明顯統(tǒng)計學差異。組A、組B和組C住院時間逐漸延長,組D與組A、組B相比住院時間無統(tǒng)計學差異,組C住院時間長于組D。組A、組B、組C住院費用逐漸增多。四組間并發(fā)癥發(fā)生率沒有統(tǒng)計學差異。[結(jié)論]從本組資料來看,7天內(nèi)手術(shù)并沒有增加中轉(zhuǎn)開腹率,保守治療后擇期手術(shù)并沒有相對減少手術(shù)時間、術(shù)中出血量及住院恢復時間。對于病程7天內(nèi)的患者在排除手術(shù)禁忌癥的情況下應(yīng)盡早手術(shù)治療,早期腹腔鏡下膽囊切除術(shù)能相應(yīng)減少手術(shù)時間、術(shù)中出血量、住院恢復時間及費用。而對與病程超過7天的病人,可根據(jù)臨床實際情況考慮是否先暫行保守治療,待癥狀緩解度過炎癥期后再擇期行LC術(shù)。
[Abstract]:[objective] to investigate the opportunity of laparoscopic cholecystectomy (LC) for acute cholecystitis in patients with acute cholecystitis. [methods] the clinical data of 171 patients with acute cholecystitis treated in Department of Hepatobiliary surgery, first affiliated Hospital of Kunming Medical University from January 2014 to December 2016 were analyzed retrospectively. According to the disease progression, all the patients were divided into 4 groups: 42 patients in group A were operated within 4 days after the onset of the disease: 44 patients in group B were operated within 4 days, 37 patients in group C were operated within 14 days after conservative treatment, 48 patients in group D received elective operation after 3 weeks of conservative treatment. The operative duration, intraoperative blood loss, conversion rate and complication rate were analyzed and compared among the four groups by statistical method, and the optimal time for surgical treatment of acute cholecystitis was discussed. [results] 150 cases of LC were successfully performed, 21 cases were transferred to laparotomy, and the conversion rate was 12.3%. The rate of conversion to laparotomy was 7.1g in group A and 11.4m in group B), which was significantly lower than that in group C (32.4%), but there was no significant difference between group B and group A. There was no significant difference between group A, group B and group D (10.4%), but the rate of conversion from group C to laparotomy was significantly different from that of the other three groups. The operative time between group A, group B and group C was prolonged gradually, the operative time of group D was shorter than that of group C, and there was no significant difference between group A and group B. The amount of D bleeding in group D was more than that in group A, but there was no significant difference between group B and group D. The hospitalization time of group A, group B and group C was prolonged gradually. Group D and group A, group B had no significant difference in hospitalization time, group C was longer than group D. The hospitalization expenses of group A, group B and group C increased gradually. There was no significant difference in the incidence of complications among the four groups. [conclusion] according to the data of this group, the rate of conversion to laparotomy has not been increased in 7 days. The selective operation after conservative treatment has not reduced the operative time, the amount of intraoperative bleeding and the time of hospital recovery. Early laparoscopic cholecystectomy could reduce the operation time, blood loss, hospital recovery time and cost. For the patients with more than 7 days course of disease, we can consider whether to take temporary conservative treatment according to the actual clinical conditions, and then to choose LC after the remission of symptoms after the inflammatory period.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.41

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