Cameron I C, Chadwick C, Phillips J, Johnson A G
University Surgical Unit, Royal Hallamshire Hospital, Sheffield, UK.
Ann R Coll Surg Engl. 2002 Jan;84(1):10-3.
A recent survey of UK general surgeons showed that almost 90% prefer to manage patients with acute cholecystitis by initial conservative management and delayed cholecystectomy (DC). The aim of this study was to assess the effectiveness of this management policy in a large university hospital.
All patients admitted with acute cholecystitis between January 1997 and June 1999 who went on to have a cholecystectomy were identified. Patients were required to have right upper quadrant pain for > 12 h, a raised white cell count and findings consistent with acute cholecystitis on ultrasound to be included in the study.
109 patients were admitted with acute cholecystitis (76 female, 33 male) with a median age of 62 years (range, 22-88 years). Conservative management failed in 16 patients (14.7%) who underwent emergency cholecystectomy due to continuing symptoms (9), empyema (4) and peritonitis (3). Symptoms settled in 93 patients and delayed cholecystectomy was performed without further problems in 66 (60.6%). 27 patients were re-admitted with further symptoms before their elective surgery and, of these, 3 were admitted for a third time before surgical intervention. Ten of the 30 re-admission episodes (33%) occurred within 3 weeks of discharge but 15 (56%) occurred more than 2 months after discharge. Elective surgery was undertaken at a median of 10 weeks post-discharge with 67% of operations occurring within 3 months. Mean total hospital stay (days) +/- SEM, for the three groups were: emergency surgery group, 10.21 +/- 0.85; uncomplicated DC group, 12.48 +/- 0.37; re-admitted group, 14.75 +/- 0.71.
The policy of conservative management and DC was successful in 60.6% of cases but 14.7% of patients required emergency surgery and 24.8% were re-admitted prior to elective surgery with a resultant increase in total hospital stay. Performing elective surgery within 2 months of discharge in all cases would have reduced the re-admission rate by 56% and this along with the increased use of early cholecystectomy during the first admission are areas where the treatment of acute cholecystitis could be significantly improved.
最近一项针对英国普通外科医生的调查显示,近90%的医生倾向于通过初始保守治疗和延迟胆囊切除术(DC)来处理急性胆囊炎患者。本研究的目的是评估这一治疗策略在一家大型大学医院中的有效性。
确定了1997年1月至1999年6月期间因急性胆囊炎入院并最终接受胆囊切除术的所有患者。患者需右上腹疼痛超过12小时、白细胞计数升高且超声检查结果符合急性胆囊炎才能纳入本研究。
109例患者因急性胆囊炎入院(76例女性,33例男性),中位年龄62岁(范围22 - 88岁)。16例患者(14.7%)保守治疗失败,因持续症状(9例)、积脓(4例)和腹膜炎(3例)接受了急诊胆囊切除术。93例患者症状缓解,66例(60.6%)顺利进行了延迟胆囊切除术,无进一步问题。27例患者在择期手术前因再次出现症状而再次入院,其中3例在手术干预前第三次入院。30次再次入院事件中有10次(33%)发生在出院后3周内,但15次(56%)发生在出院2个月后。择期手术在出院后中位10周进行,67%的手术在3个月内完成。三组患者的平均总住院天数(天)±标准误分别为:急诊手术组,10.21±0.85;无并发症的DC组,12.48±0.37;再次入院组,14.75±0.71。
保守治疗和DC策略在60.6%的病例中取得成功,但14.7%的患者需要急诊手术,24.8%的患者在择期手术前再次入院,导致总住院天数增加。所有病例在出院后2个月内进行择期手术可使再次入院率降低56%,这以及首次入院时增加早期胆囊切除术的使用是急性胆囊炎治疗可显著改善的方面。