Schäfer M, Krähenbühl L, Büchler M W
Department of Visceral and Transplantation Surgery, Inselspital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
Am J Surg. 2001 Sep;182(3):291-7. doi: 10.1016/s0002-9610(01)00702-4.
Whereas early cholecystectomy is accepted as the optimal timing for surgery, the best treatment modality for acute cholecystitis (AC) is still under debate. In this series, we aimed to assess the current treatment of AC in a single institution. In addition, preoperative criteria were defined predicting the severity of inflammation.
From January 1995 to June 1999, 236 patients undergoing cholecystectomy for AC were prospectively evaluated. Outcome measures were the treatment modality, the severity of inflammation, white blood cell (WBC) count, C-reactive protein (CRP), morbidity, and hospital stay.
There were 115 laparoscopic cholecystectomies (LC), 77 primary open cholecystectomies (OC), and 44 conversions (CON) to OC. Patients with LC were significantly younger, in better condition, with a shorter duration of symptoms and lower CRP levels and WBC counts compared with OC and CON (P <0.001). Postoperative complications, reinterventions, and mean hospital stay were significantly increased after OC and CON (P <0.001). Overall mortality was 2.5%. Advanced AC was predominantly found in OC and CON (P <0.001). Patients with advanced AC were significantly older, predominantly male, and had a prolonged duration of symptoms as well as increased CRP levels and WBC counts (P <0.001). The conversion rate increased from 10% for mild AC up to 48% for necrotizing AC.
Based on laboratory (CRP, WBC), demographic (age, sex), and individual (American Society of Anesthesiologists classification, duration of symptoms) findings, it is possible to reliably predict the severity of inflammation. Therefore, an individualized surgical approach can be used for each patient and type of AC.
虽然早期胆囊切除术被认为是手术的最佳时机，但急性胆囊炎（AC）的最佳治疗方式仍存在争议。在本系列研究中，我们旨在评估单一机构中AC的当前治疗情况。此外，还定义了预测炎症严重程度的术前标准。
1995年1月至1999年6月，对236例行AC胆囊切除术的患者进行前瞻性评估。观察指标包括治疗方式、炎症严重程度、白细胞（WBC）计数、C反应蛋白（CRP）、发病率和住院时间。
有115例行腹腔镜胆囊切除术（LC），77例行一期开放胆囊切除术（OC），44例由LC转为OC（CON）。与OC和CON组相比，LC组患者年龄显著更小，身体状况更好，症状持续时间更短，CRP水平和WBC计数更低（P<0.001）。OC和CON组术后并发症、再次干预及平均住院时间显著增加（P<0.001）。总体死亡率为2.5%。进展期AC主要见于OC和CON组（P<0.001）。进展期AC患者年龄显著更大，以男性为主，症状持续时间延长，CRP水平和WBC计数升高（P<0.001）。转换率从轻度AC的10%增至坏死性AC的48%。
基于实验室检查结果（CRP、WBC）、人口统计学特征（年龄、性别）及个体因素（美国麻醉医师协会分级、症状持续时间），可以可靠地预测炎症严重程度。因此，可针对每位患者及AC类型采用个体化手术方法。
