中国实用外科杂志

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急诊日间腹腔镜胆囊切除术可行性及影响因素分析

谢天歌,孙    嘉,马祖燚,吴    昕,李秉璐   

  1. 中国医学科学院 北京协和医学院 北京协和医院基本外科,北京 100730  
  • 出版日期:2023-04-01

  • Online:2023-04-01

摘要: 目的    探讨日间手术管理模式下完成急诊腹腔镜胆囊切除术(LC)的可行性并分析影响因素。 方法    回顾性分析2021年1—12月北京协和医院基本外科收治的急诊行LC的271例病人的临床资料。按术后住院时间分为日间管理组(住院时间≤48 h,133例)和常规组(住院时间>48 h,138例)。比较两组病人的基线资料、手术情况和术后恢复情况。结果    日间管理组与常规组病人在年龄、ASA分级、上腹部手术史、术前白细胞(WBC)计数、术前中性粒细胞百分比(NEUT%)、术前白蛋白方面比较差异有统计学意义(P<0.05)。日间管理组较常规组的手术时间缩短,且无术后并发症发生,术后放置引流和使用抗生素的比例相对较低(P<0.05)。多因素Logistic回归分析显示,高龄、上腹部手术史、ASA分级≥Ⅲ级、WBC计数和总胆红素升高是急诊LC后住院时间延长的独立危险因素。结论    在急诊医疗资源相对缺乏的情况下,经过筛选后的部分LC可以在日间手术管理模式下完成;对于高龄、有上腹部手术史、ASA分级≥Ⅲ级、WBC计数和总胆红素升高的病人,应谨慎行急诊日间LC。

关键词: 日间手术, 腹腔镜胆囊切除术, 急诊手术, 术后住院时间

Abstract: Feasibility and influence factors analysis of emergency ambulatory laparoscopic cholecystectomy        XIE Tian-ge, SUN Jia, MA Zu-yi, et al. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100730,China
Corresponding author: LI Bing-lu, E-mail: PUMCHLBL@163.com
Abstract    Objective    To investigate the feasibility of emergency LC under the management of ambulatory surgery and analyse the risk factors. Methods    The clinical data of 271 patients undergoing emergency LC were retrospectively analyzed from January 2021 to December 2021 in Peking Union Medical College Hospital. They were divided into the ambulatory group(≤48 h, 133patients) and control group(>48 h, 138patients) by the postoperative hospital stay. Demographic, clinical, surgical factors and postoperative status were measured. Results    A total of 133 patients were included in the ambulatory group and 138 patients were included in the other. There was a statistically significant difference between the two groups in the age, ASA score, history of upper abdominal surgery, preoperative white blood cell count and preoperative albumin(P<0.05). The ambulatory group had a shorter operation time, no postoperative complications, and a lower proportion of the use of drainage tubes and antibiotics(P<0.05). Multivariate logistics regression analysis showed that age≥ 65 years, history of upper abdominal surgery, ASA score≥Ⅲ, and the increase of white blood cell count and total bilirubin were independent risk factors for a postoperative hospital stay in patients undergoing emergency LC. Conclusion    In the relative absence of emergency medical resources, selected patients can be treated as a day case under the management of ambulatory surgery. For patients with risk factors, emergency ALC should be carefully recommended.

Key words: ambulatory surgical procedures, laparoscopic cholecystectomy, emergency surgery, postoperative hospital stay