Cheruvu C V N, Eyre-Brook I A
Department of Surgery, Taunton & Somerset Hospital, Taunton, UK.
Ann R Coll Surg Engl. 2002 Jan;84(1):20-2.
The aim of this study was to document the morbidity associated with long waiting times for laparoscopic cholecystectomy and to relate this to the nature of initial presentation either routine out-patient consultation or emergency admission with acute symptoms. This study was performed over a 50-month period in a DGH (serving a population of 320,000) which lacked sufficient operating capacity to allow routine early cholecystectomy after emergency admission. A total of 387 patients underwent cholecystectomy but 22 of these had an early operation after initial emergency admission with signs of peritonitis and were excluded from the study. The median waiting time for cholecystectomy in this study population of 365 patients was 170 days (range, 6-484) days. Of these 365 patients, 246 (67.4%) were listed for surgery after initial out-patient assessment (out-patient cohort) and 119 (32.6%) were diagnosed after an index emergency admission with symptomatic gallstone disease (emergency cohort). Of the 365 patients, 42 (11.5%) had one or more emergency admissions (57 admissions) with gallstone-related complications whilst on the waiting list for surgery. Complications were acute cholecystitis/biliary colic (n = 40), jaundice/cholangitis (n = 8), acute pancreatitis (n = 6) and perforated gallbladder (n = 3). Re-admissions with gallstone-related complications were much more common in patients whose initial presentation had been as an emergency. Thus, 34 of the 119 emergency cohort (28.5%) required re-admission with complications whilst only 8 of 246 (2.8%) elective cohort were re-admitted. Of the 34 re-admissions in the emergency cohort, 22 occurred within 6 weeks of their discharge from hospital. Median total and postoperative stay were significantly shorter (P < 0.001) in the elective cohort (3 and 2 days, respectively) than the emergency cohort (10 and 3 days, respectively). These results document the high incidence of complications experienced by patients waiting for an elective laparoscopic cholecystectomy. Morbidity is highest in patients with an initial emergency admission. These results suggest that cholecystectomy should be offered to all patients presenting as an emergency with symptomatic gallstones on admission.
本研究的目的是记录腹腔镜胆囊切除术等待时间过长所带来的发病率，并将其与初始就诊情况（即常规门诊咨询或急性症状的急诊入院）的性质相关联。本研究在一家地区综合医院（服务人口为32万）进行，为期50个月，该医院缺乏足够的手术能力，无法在急诊入院后进行常规的早期胆囊切除术。共有387例患者接受了胆囊切除术，但其中22例在初次因腹膜炎体征急诊入院后接受了早期手术，被排除在研究之外。本研究中365例患者胆囊切除术的中位等待时间为170天（范围为6 - 484天）。在这365例患者中，246例（67.4%）在初次门诊评估后被列入手术名单（门诊队列），119例（32.6%）在首次因有症状的胆结石疾病急诊入院后被确诊（急诊队列）。在这365例患者中，42例（11.5%）在等待手术期间因胆结石相关并发症有一次或多次急诊入院（共57次入院）。并发症包括急性胆囊炎/胆绞痛（n = 40）、黄疸/胆管炎（n = 8）、急性胰腺炎（n = 6）和胆囊穿孔（n = 3）。初次就诊为急诊的患者因胆结石相关并发症再次入院的情况更为常见。因此，119例急诊队列中的34例（28.5%）因并发症需要再次入院，而246例择期队列中只有8例（2.8%）再次入院。在急诊队列的34例再次入院患者中，22例发生在出院后6周内。择期队列的中位总住院时间和术后住院时间（分别为3天和2天）明显短于急诊队列（分别为10天和3天）（P < 0.001）。这些结果记录了等待择期腹腔镜胆囊切除术患者并发症的高发生率。初次急诊入院的患者发病率最高。这些结果表明，对于所有因有症状胆结石急诊入院的患者，都应提供胆囊切除术。
