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- 以早期手術及常規手術治療急性膽囊炎之比較
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題 名 | 以早期手術及常規手術治療急性膽囊炎之比較 |
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作 者 | 林齊宣; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 25:3 民81.05-06 |
頁 次 | 頁1166-1172 |
分類號 | 416.247 |
關鍵詞 | 早期手術; 常規手術; 急性膽囊炎; |
語 文 | 中文(Chinese) |
中文摘要 | 急性膽囊炎如果不做適當治療有時會造成膽囊穿孔、膽囊周邊濃瘍和膽汁性腹膜炎,目前以外科手術治療急性膽囊炎已普遍被採用,只是手街時機至今仍有爭論,有人主張緊急手術,有人主張先行保守療法後再擇期進行常規手術。本文共收集了本院近兩年來因急性膽囊炎而接受手術之病例共七十二人,所有病例在手術前均接受超音波檢查並確立診斷,病例平均年齡為56±12歲,其中男性24例,女性48例。我們將所有病例先分成單純急性膽囊炎(A組,47例)和合併有總膽管結石者(B組,25例),每一組再依手術方式分成兩組,其中接受早期手術者為A1組和B1組共29例,接受常規手術者為A2組和B2組共43例。結果發現早期手術與常規手術引起之罹病率和死亡率沒有統計學上之差異,反而B2組的手術時間比其他組別耗時(A1:114±26分,A2 : 113±37分,B1 : 120±22分,B2:165±33分,P < 0.05),本研究表示常規手術的困難度可能比早期手術高。至於住院日數在統計學上則有明顯差異,在單純急性膽囊炎中早期手術組比常規手術組平均少住院八日,在合併有總膽管結石者其差距為十一日。隨著時代的變遷,醫療品質與知識技術也都在進步中,若將醫療費用與社會勞動力考慮進去,早期手術似乎在情況允許之下是值得廣泛採用。 |
英文摘要 | The acute cholecystitis may be associated with complications such as the perforation of gallbladder, pericholecystic abscess and biliary peritonitis. It is generally accepted to treat the acute cholecystitis with surgical intervention, but the controversy regarding the timing of operation still exists: either elective1y or early. From 1987 to 1989, there were 72 cases who received the surgical treatments for the acute cholecystitis at the Taipei Municipa1 Chung-Hsin Hospital. All cases were diagnosed by the ultrasound before operation. These cases are divided into two groups: simple acute cholecystitis (Group A, N=47), and acute cholecystitis associated with common bile duct stones (Group B, N = 25). Each group is divided into two subgroups (A1, A2 and Bl, B2). A1 and Bl include cases received for the early operation, and A2 and B2 include cases undergoing the elective operation. The average age for all patients is 56 ±12 years old & the sex ratio is 2 to 1 with female predominant. The resu1ts show that there is no statistically significant difference between the early & elective groups in morbidity and morta1ity (13.8% vs 13.9% & 6.8% vs 4.6% respective1y). The duration of operation and the intraoperative blood loss are also near1y the same between subgroups except the more need of blood transfusion in the subgroup B2. This may indicate that the elective operation is more difficult than the early operation. As to the duration of hospital stay, there is significant difference between the early and elective groups. Compared to the elective group, the patients of simple acute cholecystitis and those associated with common bile duct stones in the early group had a shorter hospital stays with a mean of 8 days and 11 days respectively. With the progress of medical knowledge equipment and technology, the obstacles for performing the early operations exists in the past but are disappearing more recently. Considering the expense of treatment and the waste of work capacity, we may suggest that the early operations are superior to the elective operations for the acute cholecystitis. |
本系統中英文摘要資訊取自各篇刊載內容。