Clinical Effect Observation Of Laparoscopic Subtotal Cholecystectomy In Treating 3 To 7 Days Of Acute Suppurative Cholecystitis

Objective: This topic proposed by comparing laparoscopic subtotal cholecystectomy(LSC)group,the laparoscopic cholecystectomy(LC)group and by conservative treatment to improved after laparoscopic cholecystectomy(CT-LC)group at ? period of related parameters of perioperative and postoperative follow-up,explore the acute suppurative cholecystitis in 3 to 7 days of stroke onset,choose the clinical curative effect and safety of LSC operation.Methods: A total of 68 patients with acute suppurative cholecystitis with an onset of 3-7 days between December2013 and December 2019 in the General Surgery Department of Guangzhou Red Cross Hospital were selected,including those who underwent LSC,LC,and CT-LC.Data analysis was performed using SPSS statistical software.Results: There were 28 cases in the LSC group,24 cases in the LC group,and 16 cases in the CT-LC group.There was no significant difference in gender,age,infection index,liver function,and gallbladder wall thickness among the three groups(P>0.05).The operation time(min),intraoperative bleeding(ml),and postoperative first ventilation(d)time of the LSC group,LC group,and CT-LC group were [123.5 ± 10.48,150.4 ± 8.91,98.75 ± 9.71,(P <0.05)],[52.14 ± 8.35,109.54 ± 12.35,47.44 ± 8.21,(P <0.05)],[3.64 ± 1.31,4.54± 1.32,2.31 ± 1.40,(P <0.05)],both the LSC group and the CT-LC group were better than the LC group.The rate of conversion to open surgery in the LSC group and the CT-LC group was lower in 2 cases(7.1%)and 1(6.2%)than in the LC group(5)(17.8%),P=0.015.The postoperative abdominal drainage volume(ml)and the time for removing the abdominal drainage tube(d)were [53.71 ± 10.13,70.17 ± 5.79,30.69 ± 6.99,(P <0.05)],[5.50 ± 1.53,5.75 ± 1.57,2.44 ± 1.41,(P <0.05)],CT-LC group was better than LSC group and LC group.Days of hospitalization(d),total costof hospitalization(yuan)was [5.29 ± 1.58,6.75 ± 1.07,11.13 ± 1.54,(P <0.05)],[16378 ± 1427,18404 ± 1234,25836 ± 752,(P <0.05)],LSC The group was better than the LC group and the CT-LC group.Four patients(6.7%)in the LC group were converted to open abdomen,and two patients(8.3%)had abdominal infections.This was not the case in the LSC group and the CT-LC group.Patients were followed up at3 and 6 months after surgery,of which 16 were lost to follow-up.The upper abdominal pain and discomfort in the LSC group,LC group,and CT-LC group were 2(9.0%)and 1 in 3 months.(6.2%),1 case(7.1%),P = 1.000;Nausea and vomiting(1case(4.5%),1 case(6.2%),1 case(7.1%),P = 1.000;LSC group,LC group One patient(4.5%),one patient(6.2%),P = 1.000;one patient with common bile duct stones in the LC group(6.2%),P = 0.577,no other cases.At 6 months follow-up,1case(4.5%),1 case(6.2%),and 1 case(6.2%)of upper abdominal pain and discomfort in the LC group;1 case(6.2%)in the LC group,P = 0.577;No other cases.Conclusion:In the case of acute suppurative cholecystitis 3 to 7 days after onset,there is difficulty in dissecting the gallbladder triangle.Compared with LC and the conservative treatment before LC,LSC has the advantages of short operation time,low laparotomy rate,less surgical complications,and quick postoperative recovery.It also achieves the satisfactory clinical efficacy,is a safe and feasible alternative,and is worthy of popularization and application.