Abstract: ObjectiveTo study the timing of laparoscopic cholecystectomy (LC) on clinical efficacy and safety in patients with acute cholecystitis.MethodsA total of 120 patients with acute cholecystitis who underwent laparoscopic cholecystectomy in our hospital from January 2015 to March 2017 were selected and divided into three groups according to the random number table. Among them, 40 patients in the early group were treated by laparoscopic cholecystectomy within 3 days. 40 cases in the deferred group received LC in 4~21 days after the onset of acute cholecystitis. And the other 40 patients of elective group were given conservative treatments before an implementation of surgery. The perioperative period, the rate of laparotomy and postoperative complications of the three groups were compared.ResultsThere was no significant difference in bleeding volume, ambulation time and anus exhaust time between the early group and the elective group (P>0.05). The bleeding volume in the early group and the elective group was significantly less than that of the deferred group (P<0.05). Operation time and hospitalization time in the early group were significantly shorter than that of the deferred and elective groups (P<0.05). The laparotomy rate was 22.5% in the deferred group, which was significantly higher than that of the early group and the selective group. The incidence of gastrointestinal injury, liver injury, infection, bile leakage and intestinal fistula in the three groups showed no significant difference (P>0.05).Conclusion
Laparoscopic cholecystectomy in early stage (less than 3 d) is more effective in patients with acute cholecystitis, which can shorten operation time, reduce the laparotomy conversion rate and complications, and is beneficial to postoperative recovery.
焦兰农，周绍荣. 急性胆囊炎患者行腹腔镜胆囊切除术的时机选择[J]. 中国现代手术学杂志, 2017, 21(5): 340-343.
JIAO Lan-nong, ZHOU Shao-rong. Timing of Laparoscopic Cholecystectomy for Patients with Acute Cholecystitis. Chinese Journal of Modern Operative Surgery, 2017, 21(5): 340-343.
Utsumi M, Aoki H, Kunitomo T, et al. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy and the usefulness of the 2013 Tokyo Guidelines［J］.Acta Med Okayama, 2017,71(5):419425. doi: 10.18926/AMO/55440.
［4］
Ferrarese A, Gentile V, Bindi M, et al. The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor? ［J］. Open Med (Wars), 2016,11(1):489496. doi: 10.1515/med20160086.
Iwashita Y, Hibi T, Ohyama T, et al. An opportunity in difficulty: JapanKoreaTaiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy［J］. J Hepatobiliary Pancreat Sci, 2017,24(4):191198. doi: 10.1002/jhbp.440.
Paige JT, Yu Q, Hunt JP, et al. Thinking it through: mental rehearsal and performance on 2 types of laparoscopic cholecystectomy simulators［J］. J Surg Educ, 2015,72(4):740748. doi: 10.1016/j.jsurg.2015.01.012.
［10］
Zhu JG, Han W, Zhang ZT, et al. Shortterm outcomes of laparoscopic transcystic common bile duct exploration with discharge less than 24 hours［J］. J Laparoendosc Adv Surg Tech A, 2014,24(5):302305. doi: 10.1089/lap.2013.0537.
Jara G, Rosciano J, Barrios W, et al. Laparoscopic subtotal cholecystectomy: a surgical alternative to reduce complications in complex cases［J］. Cir Esp, 2017,95(8):465470. doi: 10.1016/j.ciresp.2017.07.013.
2017, Vol. 21 
