Acute Cholecystitis Operation Timing Of Clinical Research

Objective: To observe the clinical effect of different surgical timing for acute cholecystitis,analyze the difference of curative effect between different operative time,and get the best operation time for patients with acute cholecystitis.Methods: 145 Patients with acute cholecystitis from February 2015 to June 2017 in our hospital were recruited,which including 145 cases of acute calculous cholecystitis and 34 cases of non-calculous cholecystitis.In order to guarantee the timing of surgery in Patients with acute cholecystitis on clinical observation of the significance of this paper will have more contrast,145 cases of acute cholecystitis were divided into A,B,C three groups,the operation time of group A(54 cases)in 3 days,group B(34 cases)in 4-7 days,group C(23 cases)after 7 days.And 34 cases of non-calculous cholecystitis patients were divided into A group and B group,the operation time of A group(21cases)within 3 days,B group(13 cases)in 4-7 internal days.The operation time,blood loss,conversion rate,postoperative complications,postoperative exhaust time,time of hospitalization and hospitalization expenses were compared.Result:(1)In Patients with acute calculous cholecystitis: The operative time and blood loss in group A were lower than that of group B(P<0.05),but no significant difference in postoperative exhaust time and rate of conversion rate(P>0.05).Group A and B two groups compared with group C,the operation time,the amount of bleeding,the postoperative exhaust time and the conversion rate were significantly higher in group C than in group A and B,there was a significant difference between groups(P<0.05).The average hospitalization time and average hospitalization expenses of A group minimum,Group B was the next,group C was the highest,and the difference between groups was statistically significant(P<0.05).The results of postoperative complications showed that there were no incision infection and bile leakage in group A patients,but pulmonary infection in 3 cases,the total complication rate was 5.6%.No infection of incision and bile leakage and 2 cases of pulmonary infection were found in group B,the incidence of total complications was 6.1%.Of the patients in group C,1 cases had incisional infection,1 cases of bile leakage,4 cases of pulmonary infection and 1 cases of peritoneal effusion,the incidence of total complications was 30.4%.There was no significant difference in the incidence of complications in group A and two groups,but the incidence of complications in group C was significantly higher than that of group A and B two.The difference between the groups was obvious(P<0.05).(2)In acute non calculous cholecystitis: The operation time,intraoperative bleeding and postoperative exhaust time were respectively in the A group was(52.3 12.7)min、(15.8 6.7)ml、(24.2 15.7)h respectively,0 cases of conversion to open abdomen,which were(70.4 ± 10.9)min、(58.4 ± 11.6)ml、(40.3 ± 22.1)h respectively and 3 cases of conversion in B groups.Compared with two groups of A and B,the operation time,amount of bleeding,conversion rate and postoperative exhaust time in group B were significantly higher than those in the group A,and the difference between the groups was obvious(P<0.05).he average hospitalization time and average hospitalization cost in group A were significantly lower than that in group B,and the difference between the groups was obvious(P<0.05).In group A,there were no incision infection,bile leakage,postoperative intestinal obstruction,but 2 cases of pulmonary infection.The incidence of total complications was 9.5%.In group B,there were 1 cases of incision infection,1 cases of bile leakage,2 cases of pulmonary infection and 3 cases of peritoneal effusion,the incidence of total complications was 46.2%.The incidence of total complications in the B group was significantly higher than that in the A group(P<0.05).Conclusion:(1)For Patients with acute calculous cholecystitis.There was no significant difference in the total complications between 3 days and 4-7 operations.Although the operative time and intraoperative blood loss increased,the length of stay and hospitalization expenses were increased.However,there was no difference in the conversion rate of laparotomy between 3 days.Therefore,laparoscopic cholecystectomy within 7 days is still feasible.After 7 days of operation,the incidence of total complications was significantly increased in 7 days,and the rate of conversion to laparotomy was also increased.Therefore,for patients with acute calculous cholecystitis,laparoscopic cholecystectomy is best for the patient within 3 days,and the patients can still benefit from the operation within 7 days.(2)It is safe and feasible for patients with non-calculous cholecystitis to be excised within 3 days.After 3 days of operation,the complications increased significantly,the operation time,bleeding volume,hospitalization time and expenses and the conversion rate of laparotomy increased significantly.Therefore,early diagnosis and treatment should be performed.