急性膽囊炎合并肝功能異常手術(shù)時(shí)機(jī)的探討

賈曉斌

[摘要] 目的 探討急性膽囊炎合并肝功能異常患者手術(shù)時(shí)機(jī)選擇對(duì)臨床效果的影響。 方法 將我院2015年3月～2019年9月期間收治的68例急性膽囊炎合并肝功能異常患者根據(jù)不同手術(shù)時(shí)間分成兩組，早期組（發(fā)病72 h內(nèi)）36例，延期組（發(fā)病72 h后）32例。早期組患者直接給予腹腔鏡手術(shù)治療，延期組患者肝功能改善后給予腹腔鏡手術(shù)治療，對(duì)比兩組圍術(shù)期臨床指標(biāo)、手術(shù)前后生化指標(biāo)及并發(fā)癥發(fā)生率。 結(jié)果 在術(shù)中出血量方面，組間無(wú)統(tǒng)計(jì)學(xué)差異（P>0.05）;在手術(shù)時(shí)間、住院時(shí)間、住院費(fèi)用方面，早期組少于延期組，組間有統(tǒng)計(jì)學(xué)差異（P<0.05）。兩組手術(shù)后5 d總膽紅素（TBIL）、直接膽紅素（DBIL）、堿性磷酸酶（ALP）、谷氨酰轉(zhuǎn)移酶（GGT）、丙氨酸轉(zhuǎn)氨酶（ALT）水平顯著低于手術(shù)前（P<0.05），但組間無(wú)統(tǒng)計(jì)學(xué)差異（P>0.05）。早期組并發(fā)癥發(fā)生率為5.56%，延期組為6.25%，組間無(wú)統(tǒng)計(jì)學(xué)差異（P>0.05）。 結(jié)論 急性膽囊炎合并肝功能異常患者應(yīng)用早期腹腔鏡手術(shù)治療與延期腹腔鏡手術(shù)治療的效果相當(dāng)，但前者能夠減少手術(shù)時(shí)間，顯著減輕患者經(jīng)濟(jì)壓力，且安全可靠，值得臨床推廣應(yīng)用。

[關(guān)鍵詞] 急性膽囊炎;肝功能異常;腹腔鏡手術(shù);生化指標(biāo);并發(fā)癥

[中圖分類號(hào)] R657.41 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] B ? ? ? ? ?[文章編號(hào)] 1673-9701（2020）15-0056-03

Discussion on the surgery time of acute cholecystitis combined with abnormal liver function

JIA Xiaobin

Department of General Surgery， Hai'an Traditional Chinese Medicine Hospital in Jiangsu Province， Hai'an ? 226600， China

[Abstract] Objective To explore the impact of surgery time on the clinical effect in acute cholecystitis combined with abnormal liver function. Methods 68 cases of acute cholecystitis combined with liver dysfunction admitted in our hospital from March 2015 to September 2019 were divided into two groups according to different surgery time， with 36 cases in the early group（within 72 hours of onset）， and 32 cases in the delayed group（after 72 hours of onset）. Patients in the early group were given laparoscopic surgery directly， and patients in the delayed group were given laparoscopic surgery after improvement of liver function. The perioperative clinical indicators， biochemical indicators before and after surgery and the incidence of complications were compared between the two groups. Results There was no statistical difference in intraoperative blood loss between the groups（P>0.05）. The operation time， hospitalization time， and hospitalization costs in the early group were less than those of the delayed group， with statistical difference between the groups（P<0.05）. The total bilirubin（TBIL）， direct bilirubin（DBIL）， alkaline phosphatase（ALP）， glutamyl transferase（GGT）， and alanine transaminase（ALT） levels after 5 days of surgery were significantly lower than those before surgery in the two groups（P<0.05）， but there was no statistical difference between the groups（P>0.05）. There was no statistical difference in the complication rate between the early group（5.56%） and the delayed group（6.25%， P>0.05）. Conclusion For patients with acute cholecystitis and abnormal liver function， early laparoscopic surgery is equivalent to delayed laparoscopic surgery. But the former can reduce the operation time， significantly reduce the economic pressure of patients， which is safe and reliable. It is worthy of clinical application.