Résumé
Objective To explore the difference between the curative effect and the prognosis under different time of surgery for calculus incarcerated cholecystitis patients.Methods Ninty-three cases of acute cholecystitis caused by stone inlay in the neck of the gallbladder patients in Xiaogan First People's Hospital from April 2013 to April 2015 were divided into group A and group B according to the duration.Group A:the course of disease was within 72 hours(n =43).Group B:the course of disease was over 72 hours (n =50).The observation indicators of the two groups included (1)operation condition:operation time,postoperative anal exhaust time,postoperative pain time,intraoperative blood loss and length of hospital stay;(2) conversion to laparotomy situation;(3) the postoperative complications of pulmonary infection,abdominal infection,incision infection,bile leakage.All the patients were followed up by outpatient or telephone,inquiried and recorded patient's health status.The deadline for follow-up was October 2015.The measurement data were expressed by ((x) ± s) and comparison between groups was analyzed by using t test.Count data were analyzed using x2 test.Results (1) The average operation time,postoperative anal exhaust time,postoperative pain time,intraoperative blood loss and hospitalization time of group Awere (56.4±12.7) minutes,(37.8±4.6) hours,(24.2±3.8) hours,(58.3± 14.3) ml,(4.8± 2.9) days respectively,the data of group B were (82.5 ± 15.8) minutes,(76.2 ±7.8) hours,(53.8 ± 7.8) hours,(71.4 ± 16.9) ml,(7.8 ± 2.5) days respectively,the difference between the two groups were statistically significant (all P ＜ 0.05);(2) The conversion rate of laparotomy in group A (4.65％,2/43) was significantly less than group B (18.00％,9/50),and the difference was statistically significant (P ＜ 0.05);(3)The complication rate in group A (4.65％,2/43) was significantly less than group B (16.00％,8/50),and the difference was statistically significant (P ＜ 0.05).Conclusion The prognosis of calculous incarcerated cholecystitis with different surgical time is significantly different,the prognosis of the patients duration within 72 hours surgery prognosis was significantly better than the duration more than 72 hours surgery.
Résumé
Objective To investigate the clinical curative effect of laparoscopic cholecystectomy in the treatment of elderly patieuts with acute gaugrenous cholecystitis,and summarized the advantages and disadvantages compared with open cholecystectomy.Methods Using retrospective study,68 elderly patients with acute gangrenous cholecystitis patients in Xiaogan First People's Hospital from January 2010 to January 2015 were selected,and divided into minimally invasive group (36 cases) and laparotomy group (32 cases) according to the different surgical treatment methods,the minimally invasive group patients were treated with laparoscopic cholecystectomy,the laparotomy group patients were treated with open cholecystectomy.Recorded and statistical analysised the incision length,operative time,intraoperative blood loss,laparotomy,postoperative first exhaust time,drainage tube pulled out of time,the degree of pain after operation (visual analogue scale),length of hospital stay,postoperative complications of the two groups.All the patients were followed up by outpatient or telephone,inquiried and recorded the patient's health status up to July 2015.The measurement data were expressed by (x ± s),and the t test was used comparison between groups.The enumeration data was expressed by percentage (％),and the x2 test was used comparison between groups.Results The incision length,intraoperative blood loss,postoperative first exhaust time,length of hospital stay,extubation time were respectively (4.67 ±2.13) cm,(65.67 ±23.61) ml,(31.18 ±4.35) hours,(7.53 ±2.33) days,(2.44±1.31) days in the minimallyinvasive group and (8.48 ±3.49) cm,(103.96 ±35.65) ml,(40.41 ±5.87) hours,(12.34 ±2.94) days,(3.73 ± 1.52) days in the laparotomy group,with statistically significant differences between the 2 groups (all P ＜ 0.05).There was no significant difference in the operation time between the two groups (t =3.574,P ＞ 0.05);The pain scores in the minimally invasive group after 1,3,5 and 7 days were respectively (4.96 ± 1.38) scores,(3.48 ± 1.04) scores,(2.01 ± 0.89) scores,(1.11 ± 0.85) scores and (6.55±1.84) scores,(5.69±1.54) scores,(2.97± 16) scores,(1.81 ±0.94) scores in the laparotomy group,with statistically significant differences between the 2 groups (all P ＜ 0.05).The incidence of complications in minimally invasive group was 17.14％ 6/35),which was significantly lower than that of laparotomy group 41.94％ (13/31) (x2 =15.234,P ＜ 0.05),all the complications were relieved after symptomatic treatment such as anti infection,drainage and so on.All patients were followed up.Among 68 patients enrolled in the study group,1 patient in the minimally invasive group was converted to laparotomy because of excessive adhesion and uncontrollable intraoperative bleeding.The laparotomy group died of septic shock in 1 case,and the remaining patients were treated by surgical treatment.Conclusion Cholecystectomy is effective in treatment of elderly patients with acute gangrenous cholecystitis,and laparoscopic cholecystectomy has the advantages of small incision,less bleeding,less pain,fewer complications and faster recovery after operation thus deserving popularization.