目的:分析腹腔镜胆囊切除术治疗急性化脓性胆囊炎患者的临床治疗效果。方法:选取我院2015年2月~2021年2月收治的82例急性化脓性胆囊炎患者为对象,按手术治疗方法将其分为两组(对照组采取常规手术治疗;观察组采取腹腔镜胆囊切除手术治疗),各组41例,比较两组患者临床效果。结果:观察组临床效果显著优于对照组,数据比较差异显著,具有统计学意义。结论:在急性化脓性胆囊炎患者中,采取腹腔镜胆囊切除术治疗,可减少患者术后卧床时间及住院时间、提高术后患者满意度等,从而提高临床效果。 Objective: To analyze the clinical therapeutic effect of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. Methods: 82 patients with acute suppurative cholecystitis admitted to our hospital from February 2015 to February 2021 were selected as subjects, and they were divided into two groups according to surgical treatment methods, they were divided into two groups (conventional surgery was used in the control group; the observation group was treated by laparoscopic cholecystectomy), 41 cases in each group, and the clinical effects of the two groups were compared. Results: The clinical effect of the observation group was significantly better than that of the control group, and the data were significantly different and statistically significant. Conclusion: In patients with acute suppurative cholecystitis, laparoscopic cholecystectomy can reduce the postoperative bed time and hospital stay, improve postoperative patient satisfaction, etc., thereby improving the clinical effect.
目的:分析腹腔镜胆囊切除术治疗急性化脓性胆囊炎患者的临床治疗效果。方法:选取我院2015年2月~2021年2月收治的82例急性化脓性胆囊炎患者为对象,按手术治疗方法将其分为两组(对照组采取常规手术治疗;观察组采取腹腔镜胆囊切除手术治疗),各组41例,比较两组患者临床效果。结果:观察组临床效果显著优于对照组,数据比较差异显著,具有统计学意义。结论:在急性化脓性胆囊炎患者中,采取腹腔镜胆囊切除术治疗,可减少患者术后卧床时间及住院时间、提高术后患者满意度等,从而提高临床效果。
腹腔镜胆囊切除手术,急性化脓性胆囊炎,临床效果,分析
Yin Jiang
Ruxi Hospital of Chongqing Zhong Traditional, Chongqing
Received: Aug. 14th, 2021; accepted: Sep. 6th, 2021; published: Sep. 15th, 2021
Objective: To analyze the clinical therapeutic effect of laparoscopic cholecystectomy for patients with acute suppurative cholecystitis. Methods: 82 patients with acute suppurative cholecystitis admitted to our hospital from February 2015 to February 2021 were selected as subjects, and they were divided into two groups according to surgical treatment methods, they were divided into two groups (conventional surgery was used in the control group; the observation group was treated by laparoscopic cholecystectomy), 41 cases in each group, and the clinical effects of the two groups were compared. Results: The clinical effect of the observation group was significantly better than that of the control group, and the data were significantly different and statistically significant. Conclusion: In patients with acute suppurative cholecystitis, laparoscopic cholecystectomy can reduce the postoperative bed time and hospital stay, improve postoperative patient satisfaction, etc., thereby improving the clinical effect.
Keywords:Laparoscopic Cholecystectomy, Acute Purulent Cholecystitis, Clinical Effect, Analysis
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胆囊炎是一种比较常见的消化道疾病,根据起病的缓急可以分为急性胆囊炎和慢性胆囊炎,常常并发于胆囊结石后发生。而急性化脓性胆囊炎是胆囊炎的一种,作为一种常见的急症,具有起病急、进展快等特点,患者同时还伴随呕吐、恶心等症状 [
本次研究选择2015年2月~2021年2月我7院82例急性化脓性胆囊炎患者资料进行回顾分析,患者平均年龄45.5岁。对照组41例,男患21例、女患20例,采取常规手术治疗;观察组中30例男患,11例女患者,采取腹腔镜胆囊切除手术治疗。两组患者在一般资料方面的比较差异无统计学意义,具有可比性。本研究获医院医学伦理委员会审批,患者及家属均签署知情同意书。
对照组采取常规手术治疗;在手术治疗前,应对患者进行全麻处理,引导患者呈仰卧位,取患者右侧肋缘下斜切口长4~10 cm,将患者腹壁逐层切开,进入腹腔后将胆囊动脉、胆囊管结扎,从胆囊床上将胆囊剥离,采取顺切法将胆囊切除,随后将引流管置于其中,做缝合处理 [
观察组采取腹腔镜胆囊切除术治疗:准备工作与对照组相同,对患者常规消毒,对患者采取4孔法对气腹进行建立 [
病例纳入标准:1) 急性起病,包括慢性胆囊炎急性发作;2) B超或CT或MRI等影像学检查提示胆囊增大,囊壁水肿增厚,胆汁透声差,胆囊周围积液,胆囊壁阶段性变薄或不连续;3) 临床症状、体征和实验室检查符合急性化脓性胆囊炎诊断。
病例排除标准:1) 既往有腹部手术史,如阑尾炎手术、结直肠手术、剖宫产手术等,估计腹腔有广泛粘连者;2) 相关检查提示合并肝内外胆管结石;3) 严重脏器功能障碍导致不能建立气腹者,包括凝血功能障碍;4) 合并肝胆肿瘤。
比较两组术后患者满意度、第一次排气时间、自由活动时间、术后住院时间、术后肠蠕动恢复时间及疼痛评分。
对本次研究数据,采取统计学软件SPSS20.0展开分析。计数资料以(%)表示,行χ2检验;计量资料以( x ¯ ± s )表示,行t检验。P <0.05认为差异有统计学意义。
对两组患者进行术后满意度回访,进行满意度对比发现观察组术后满意率显著高于对照组,(P<0.05)。见表1。
组别 | 数值(n) | 非常满意 | 一般满意 | 不满意 | 满意率(%) |
---|---|---|---|---|---|
观察组 | 41 | 28 | 12 | 1 | 97.56 |
对照组 | 41 | 13 | 19 | 9 | 78.04 |
X2 | / | / | / | / | 7.2889 |
P值 | / | / | / | / | 0.0069 |
表1. 两组患者治疗满意率分析对比(%)
观察组患者术后第一次排气时间、自由活动时间、术后住院时间均短于对照组(P < 0.05)。见表2。
组别 | 例数 | 第一次排气时间(h) | 自由活动时间(d) | 术后住院时间(d) |
---|---|---|---|---|
观察组 | 41 | 7.5 ± 1.2 | 5.7 ± 1.1 | 3.5 ± 1.9 |
对照组 | 41 | 12.2 ± 2.9 | 13.5 ± 5.3 | 7.2 ± 2.1 |
t | 6.055 | 9.103 | 10.025 | |
P | <0.05 | <0.05 | <0.05 |
表2. 两组患者治疗后第一次排气时间、自由活动时间、术后住院时间比较( x ¯ ± s )
观察组患者术后肠蠕动恢复时间短于对照组,术后疼痛评分观察组明显小于对照组。见表3。
分组 | 术后肠蠕动恢复时间(d) | 术后疼痛评分(分) |
---|---|---|
观察组 | 2.55 ± 0.25 | 2.09 ± 1.21 |
对照组 | 3.15 ± 1.25 | 7.25 ± 1.57 |
表3. 两组患者术后肠蠕动恢复时间、疼痛评分比较
急性化脓性胆囊炎为常见急腹症,胆囊管阻塞、细菌侵袭为其主要致病因素,绝大多数患者合并胆囊结石,其中合并胆囊管结石嵌顿的患者病情较重,治疗难度大 [
本文通过对本院82例急性化脓性胆囊炎患者资料进行回顾分析,就术后各项指标分析,如第一次排气时间、自由活动时间、术后住院时间、术后肠蠕动恢复时间、疼痛评分,腹腔镜下胆囊切除术较常规手术具有更好的优势(如表2、表3所示)。术前、术中、术后的一些选择对腹腔镜下胆囊切除术的术后临床效果也具有密切关系。如术前时机的选择,有报道通过数据分析得出,急性化脓性胆囊炎患者行腹腔镜下胆囊切除术是可行的,在发病72 h内行腹腔镜下胆囊切除术治疗可缩短手术时间,减少术中出血量,减少术后腹腔引流管置管时间,缩短术后住院时间,且术后并发症的发生率更低,有利于患者快速康复,对于发病超过72 h的急性化脓性胆囊炎患者,若无绝对手术禁忌症也可行腹腔镜下胆囊切除术,但手术难度大、风险高,应谨慎操作 [
综上,在我院急性胆囊炎患者中采取腹腔镜胆囊切除术治疗,可提高临床疗效,降低患者的疼痛评分,值得临床应用及推广。
蒋 银. 腹腔镜胆囊切除手术治疗急性化脓性胆囊炎的临床效果分析 Analysis of the Clinical Effect of Laparoscopic Cholecystectomy for Acute Suppurative Cholecystitis[J]. 临床医学进展, 2021, 11(09): 4020-4024. https://doi.org/10.12677/ACM.2021.119586