摘要
目的 :探讨急性结石性胆囊炎急诊手术的可能性和优越性。方法 :按李缨来分类方法把 188例急性结石性胆囊炎急诊手术分为早期手术组 (组Ⅰ ,n =87)、延期手术组 (组Ⅱ ,n =6 2 )和晚期手术组 (组Ⅲ ,n =39) ,并对手术时间、总并发症、胆囊壁有无坏死、平均医疗费用、死亡率和治疗结果进行统计学分析比较。结果 :胆囊壁坏死晚期和延期 ,手术组明显高于早期手术组 (P <0 .0 5 ) ;平均医疗费用和死亡率 ,组Ⅲ高于组Ⅰ和组Ⅱ (P <0 .0 5 ) ;组Ⅰ、组Ⅱ治疗结果明显优于组Ⅲ (P <0 .0 5 )。结论 :急性结石性胆囊炎急诊早期手术优于延期和晚期手术。急性胆囊炎发病后一周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。
Objective:To disuss the feasibility and the priority of urgent cholecystectomy in different intervals following the onset of acute gallstone cholecystitis.Methods:According to Lee's classification,our 188 cases of acute gallstone cholecystitis were divided into 3 groups,namely,early cholecystectomy group(Ⅰ),87 patients,early surgery undertaken within 72 hours following the onset of acute gallstone cholecystitis;delayed cholecystectomy group(Ⅱ),62 cases,intervention within 72 hours to a week,and late cholecystectomy group(Ⅲ),39 cases,surgery done within a week to two weeks. Statistic analysis was made in terms of operating time,incidences of postoperative complication,gallbladder wall necrosis,hospital cost,operative mortality and therapeutic result.Results:Gallbladder necrosis,11.5%,27.4%,30.8%,the incidence of necrosis was significantly lower in group Ⅰ than in group Ⅱ(P<0.05) and group Ⅲ(P<0.01);average hospital cost and mortality were significantly higher in group Ⅲ than in group Ⅰ(P<0.05) and group Ⅱ(P<0.05);therapeutic result was significantly better in group Ⅰ and Ⅱ than in group Ⅲ(P<0.05).Conclusion:Early cholecystectomy is superior to all others for the patients of acute gallstone cholecystitis. Acute gallstone cholecystectomy can be safely undertaken in different intervals within a week following the onset of acute gallstone cholecystitis. When the course of acute cholecystitis was over a week,drug therapy can be suggested.
出处
《肝胆胰外科杂志》
CAS
2002年第1期33-35,共3页
Journal of Hepatopancreatobiliary Surgery
关键词
结石性胆囊炎
胆结石
早期手术
gallstone cholecystitis
cholelithiasis
early surgery
