Efficacy Analysis Of Early Acute Cholecystitis Laparoscopic Cholecystectomy According To "Tokyo Guidelines"

Objective:This retrospective study was to investigate the acute cholecystitis patients under the " Tokyo Guidelines" rating guide line of feasibility of early laparoscopic cholecystectomy,while assessing the " Tokyo Guidelines" treatment program if it has clinical value.Methods:According to the " Tokyo Guidelines" rating in our hospital from January 2013 to January 2016 a total of 151 cases of acute cholecystitis underwent laparoscopic cholecystectomy, divided into two groups based on the timing of surgery, early LC(early LC, ELC) implementation LC group(after the completion of the onset of symptoms within 72 h LC, including emergency LC) and a total of 73 cases of delayed LC(delayed LC, DLC) group(more than 72 h of symptom onset underwent LC) 78 cases. All patients were hospitalized during the first; comparing two groups of patients before surgery general information and operation time, blood loss, abdominal transit rate, severe adhesions around the gallbladder, indwelling drainage tube, incidence of postoperative complications, postoperative hospital stay and total hospital stay if there is statistically significant difference; Further analysis of the diagnosis and treatment procedures with "Tokyo Guidelines" group and does not meet the "Tokyo guidelines" set in the timing of surgery, operative time, blood loss, abdominal transit rate, complication rate, indwelling drainage tube, preoperative hospital stay, postoperative hospital stay and total hospitalization time whether there are significant differences.Results:ELC and DLC group of patients in the preoperative duration of hospitalization,WBC count, Murphy’s sign and gallbladder wall thickness having a statistically significant difference(P <0.05), other had no significant difference(P> 0.05). Operative time, blood loss, severe adhesion around the gallbladder, indwelling drainage tube,complications and postoperative hospital stay no statistically significant(P> 0.05).Laparotomy rate and total hospital stay were significant(P <0.05). In line with "Tokyo Guide" group and does not meet the "Tokyo Guidelines" set in the timing of surgery,laparotomy rate, preoperative length of stay and total hospitalization tim were statistically significant(P <0.05), and the operation time, the amount of severe adhesions around the gallbladder, indwelling drainage tube, complications and postoperative hospital stay was not statistically significant(P>0.05).Conclusion:"Tokyo’s Guidelines" has a good clinical guidance value for acute cholecystitis surgical treatment for patients with mild and moderate acute cholecystitis, fewer complications in the situation, as soon as possible the implementation of laparoscopic cholecystectomy, can effectively reduce the rate of conversion to open surgery,postoperative hospital stay and total hospitalization time, to a certain extent, can indirectly reduce hospitalization costs and improve health care resource utilization.