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目的总结急性结石性胆囊炎腹腔镜手术时机的选择及其对生活质量的影响。方法回顾性收集笔者所在医院于2013年5月至2015年5月期间收治的200例行腹腔镜手术的急性结石性胆囊炎患者,按手术距症状出现时间分为4组:<24 h组62例、24~48 h(含48 h)组58例、48~72 h(含72 h)组47例及>72 h组33例,比较4组患者的术中出血量、手术时间、术后住院时间、住院费用、中转开腹率及术后短期并发症发生率,并比较4组患者术前、出院时及术后6个月时的消化病生存质量指数(GLQI)评分。结果 <24 h组患者的术中出血量和手术时间均少于或短于24~48 h组、48~72 h组及>72 h组(P<0.05),且>72 h组的上述2个指标均多于或长于24~48 h组和48~72 h组(P<0.05);>72 h组的住院时间和中转开腹率均长于或高于<24 h组、24~48 h组及48~72 h组(P<0.05)。术前4组患者的GLQI评分比较差异无统计学意义(P>0.05);出院时<24 h组患者的GLQI评分高于24~48 h组、48~72 h组和>72 h组(P<0.05);术后6个月时4组患者的GLQI评分比较差异无统计学意义(P>0.05)。结论急性结石性胆囊炎患者发病72 h内为腹腔镜下胆囊切除的手术时机,尤其在24 h内行腹腔镜胆囊切除术不仅安全可行,而且有利于提高患者出院时的生活质量。
Objective To summarize the timing of laparoscopic surgery for acute calculous cholecystitis and its impact on quality of life. Methods The retrospectively collected 200 patients with acute calculous cholecystitis undergoing laparoscopic surgery admitted to our hospital from May 2013 to May 2015 were divided into 4 groups according to the appearance time of the operation: Among them, there were 58 cases in 24-48 h (including 48 h) group, 47 cases in 48-72 h (72 h) group and 33 cases in> 72 h group. The intraoperative blood loss, operation time, Length of stay, cost of hospitalization, rate of laparotomy, and incidence of postoperative short-term complications. The GLQI score was compared between the four groups before, at, and 6 months after operation. Results The amount of bleeding and operation time in 24 h group were less than or shorter than those in 24-48 h group, 48-72 h group and> 72 h group (P <0.05), and those in> 72 h group (P <0.05). The hospital stay and the rate of laparotomy in> 72 h group were both longer and longer than those in <24 h group, and those in 24 h and 48 h Group and 48 ~ 72 h group (P <0.05). There was no significant difference in GLQI scores between the four groups before operation (P> 0.05). The GLQI score of patients in <24 h group was significantly higher than that in 24-48 h group, 48-72 h group and> 72 h group <0.05). There was no significant difference in GLQI score between the 4 groups at 6 months after surgery (P> 0.05). Conclusion Laparoscopic cholecystectomy is an effective treatment for patients with acute calculous cholecystitis within 72 hours after onset of laparoscopic cholecystectomy. Laparoscopic cholecystectomy is safe and feasible especially within 24 hours, and helps to improve the quality of life at discharge.