Eldar S, Eitan A, Bickel A, Sabo E, Cohen A, Abrahamson J, Matter I
Department of Surgery, Bnai Zion Medical Center, Haifa, Israel.
Am J Surg. 1999 Oct;178(4):303-7. doi: 10.1016/s0002-9610(99)00172-5.
Laparoscopic cholecystectomy is now used in the management of acute cholecystitis. Under these circumstances unfavorable conditions may result in conversion and complications. Information about these conditions may help in planning the laparoscopic approach or in proceeding directly to open cholecystectomy. This study was initiated to evaluate perioperative factors associated with conversion and complications of laparoscopic cholecystectomy in acute cholecystitis. Special attention was paid to the duration of complaints until surgery, to the delay on the part of the patient, and to the delay on the part of the physician.
Between January 1994 and December 1997, we attempted to perform laparoscopic cholecystectomy on 348 patients with acute cholecystitis. All perioperative data were collected on standardized forms.
There were 182 cases (52%) of acute uncomplicated cholecystitis, 90 (26%) of gangrenous cholecystitis, 33 of hydrops (9.5%), and 43 of empyema of the gallbladder (12.5%). Seventy six patients (22%) needed conversion to open cholecystectomy and complications occurred in 57 cases. Advanced cholecystitis was associated with significant patient delay (P = 0.01), and it had a significantly higher conversion rate (39%) compared with early cholecystitis (14.5%); (P <0.00001). Conversion rates were also associated with male gender (P = 0.0017), a history of biliary disease (P = 0.0085), and a patient delay of >48 hours (P = 0.028). The total and infectious complication rates were associated with an age older than 60 years (P = 0.023 and 0.007, respectively) and male gender (P = 0.026 and 0.014, respectively).
In acute cholecystitis, patient delay is associated with a high conversion rate. Early timing of laparoscopic cholecystectomy tends to reduce the conversion rate, as well as the total and the infectious complication rates. Male gender, a history of biliary disease, and advanced cholecystitis are associated with conversion. Male and older patients are associated with a high total and infectious complication rates.
腹腔镜胆囊切除术目前用于急性胆囊炎的治疗。在这种情况下，不利条件可能导致中转开腹及并发症。了解这些情况有助于规划腹腔镜手术方案或直接进行开腹胆囊切除术。本研究旨在评估与急性胆囊炎腹腔镜胆囊切除术中转开腹及并发症相关的围手术期因素。特别关注了手术前症状持续时间、患者延误及医生延误。
1994年1月至1997年12月期间，我们尝试对348例急性胆囊炎患者行腹腔镜胆囊切除术。所有围手术期数据均收集于标准化表格。
急性非复杂性胆囊炎182例（52%），坏疽性胆囊炎90例（26%），胆囊积水33例（9.5%），胆囊积脓43例（12.5%）。76例患者（22%）需要中转开腹胆囊切除术，57例发生并发症。重度胆囊炎与显著的患者延误相关（P = 0.01），与早期胆囊炎相比，其中转开腹率显著更高（39% 对14.5%）；（P <0.00001）。中转开腹率还与男性性别（P = 0.0017）、胆道疾病史（P = 0.0085）及患者延误>48小时（P = 0.028）相关。总体并发症率及感染性并发症率与年龄大于60岁（分别为P = 0.023和0.007）及男性性别（分别为P = 0.026和0.014）相关。
在急性胆囊炎中，患者延误与高中转开腹率相关。早期进行腹腔镜胆囊切除术往往可降低中转开腹率以及总体并发症率和感染性并发症率。男性性别、胆道疾病史及重度胆囊炎与中转开腹相关。男性及老年患者总体并发症率和感染性并发症率较高。
