高原地区和非高原地区腹腔镜胆囊切除术的比较

【】　目的　探讨高原地区腹腔镜胆囊切除术（laparoscopiccholecystectomy，LC）患者的特点，以便更好地进行围手术期处理。　方法　对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者（高原组）367例和非高原地区患者（非高原地区组）167例的一般资料、术前诊断、合并症情况进行回顾性分析，两组患者性别、年龄及病程比较，差异无统计学意义（P>0.05），有可比性。两组患者诊断均以胆囊结石为主，其次为胆囊息肉，诊断构成比较，差异无统计学意义（P>0.05）；两组患者合并症比较，高原组患者高血压、冠心病、血红蛋白增多症及窦性心动过缓的发生率高于非高原地区组（P0.05）。两组患者均采用常规LC进行治疗，对两组患者术后临床结果、并发症等进行统计学分析。　结果　高原组患者手术中转开腹率（7.1%）高于非高原地区组（2.4%）患者（P0.05）。　结论　高原地区LC患者宜及时中转开腹，其围手术期处理得当将有助于减少术后并发症的发生。【Abstract】　Objective　Toexplorethecharacteristicsofpatientsundergoinglaparoscopiccholecystectomyinhighlandarea,inordertocarryoutbetterperioperativemanagement.　Methods　Wecollectedandanalyzedthegeneralinformation,preoperativediagnosisandcomplicationsof367patientslivinginhighlandareaand167patientslivingininlandbetweenFebruary2009andMay2010.Therewasnosignificantdifferencebetweenthetwogroupsinsex,ageandcourseofdisease(P>0.05).Cholecystolithiasiswasthemaindiseasefollowedbygallbladderpolyps,andtherewasnodifferencebetweentheminthekindofdiseases(P>0.05).Theincidenceofhypertension,coronaryheartdisease,hereditarypersistenceoffetalhemoglobinandsinusbradycardiawashigherinpatientsinhighlandareathanthatinpatientsinnon-highlandarea(P0.05).Conventionallaparoscopiccholecystectomywasconductedinbothtwogroups.Comparativeanalysisoftreatmentoutcomeandpostoperativecomplicationswasdone.　Results　TherateofconversionfromlaparoscopicsurgerytolaparotomyinTibetanpatients(7.1%)washigherthanthatinpatientsinnon-highlandarea(2.4%)(P0.05).　Conclusions　Laparoscopiccholecystectomyforpatientsinhighlardareashouldbeconvertedtolaparotomywhennecessary.Appropriateperioperativemanagementishelpfulinreducingtheincidenceofpostoperativecomplications.