急性胆囊炎合并肝功能异常手术时机的探讨

贾晓斌

[摘要] 目的 探討急性胆囊炎合并肝功能异常患者手术时机选择对临床效果的影响。 方法 将我院2015年3月～2019年9月期间收治的68例急性胆囊炎合并肝功能异常患者根据不同手术时间分成两组，早期组（发病72 h内）36例，延期组（发病72 h后）32例。早期组患者直接给予腹腔镜手术治疗，延期组患者肝功能改善后给予腹腔镜手术治疗，对比两组围术期临床指标、手术前后生化指标及并发症发生率。 结果 在术中出血量方面，组间无统计学差异（P>0.05）;在手术时间、住院时间、住院费用方面，早期组少于延期组，组间有统计学差异（P<0.05）。两组手术后5 d总胆红素（TBIL）、直接胆红素（DBIL）、碱性磷酸酶（ALP）、谷氨酰转移酶（GGT）、丙氨酸转氨酶（ALT）水平显著低于手术前（P<0.05），但组间无统计学差异（P>0.05）。早期组并发症发生率为5.56%，延期组为6.25%，组间无统计学差异（P>0.05）。 结论 急性胆囊炎合并肝功能异常患者应用早期腹腔镜手术治疗与延期腹腔镜手术治疗的效果相当，但前者能够减少手术时间，显著减轻患者经济压力，且安全可靠，值得临床推广应用。

[关键词] 急性胆囊炎;肝功能异常;腹腔镜手术;生化指标;并发症

[中图分类号] R657.41          [文献标识码] B          [文章编号] 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.