The Research Of Opportunity Selection In Acute Calculous Cholecystitis Laparoscopic Cholecystectomy

Acute cholecystitis is a common acute abdomen. The pathological basis of gallstoneobstruction of the cystic duct causing acute cholecystitis. If the obstruction can not beremoved, the pressure continues to rise in the gallbladder, inflammation showedprogressive development, expansion, ischemia and infection combined action leads tosimple inflammation, purulent inflammation, necrosis, perforation, abscess around thegallbladder or bile peritonitis. Laparoscopic cholecystectomy (LC) is a minimallyinvasive surgery, the patient suffer less pain, receive faster recovery, has become thepreferred treatment for gallstones, and are increasingly being used to treat acutecholecystitis at the same time.It have replaced open abdominal surgery in the treatmentof gallstones.But in the treatment of acute cholecystitis, there are still controversial ofLC, most scholars prefer early surgery,72h of onset time as emergency gallbladderremoval surgery.They thought LC is safe, reliable, simple to operate within72h. Andafter72h,gallbladder local congestion, edema, severe adhesion made the surgicalseparation difficult, so the condition of such patients tend to conservative treatment.Anda few weeks later to implement cholecystectomy But now, abroad many doctorsobjected the time within72h to surgery. In order to investigate the emergencycholecystitis timing of laparoscopic surgery, this study conducted a retrospective studyof217patients with acute cholecystitis underwent LC calculus in our hospital fromJanuary2009to December2013.Objective: Investigae the surgery time of laparoscopic cholecystectomy of acutecholecystitis. Methods: Retrospective analysis of217cases of acute cholecystitis underwent LCclinical data from Hospital of Dalian Economic Technological Development Zone inJanuary2009-December2013.We divided it into3groups according to the course:the course of72h for the group A (n=95), duration of72h~1week for the group B(n=78), over the course of one week for the group C (n=44); comparison betweenoperative time, blood loss, laparotomy rate, postoperative exhaust time, postoperativehospital stay and hospital costs. LC surgical method using four holes.Results: LC was completed successfully in208of the patients，the other9wereconvened to open surgery(4．14％)．The rate of conversion to open surgery was0％and5.1％in group A and B respectively，which were both significantly lower than thatin the group C(11.4)(P<0.05)．Group A showed significantly shorter operation time，exhaust time and complication than those in group B and C，and those in group B werealso significantly better than group C．Conclusion: With the extension of time before1aparoscopic cholecystectomy forAcute Cholecystiti, operative time, blood loss, conversion to open surgery andpostoperative complication rates were significantly increased, but no significant effecton postoperative hospital stay. So for patients with acute cholecystitis within72h shouldbe taken LC on time，because it has shorter operative time, less blood loss, fewercomplications, and for patients with onset over72h, should take LC as early as possible.