Somasekar K, Shankar P J, Foster M E, Lewis M H
Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, UK.
Postgrad Med J. 2002 Nov;78(925):668-9. doi: 10.1136/pmj.78.925.668.
Laparoscopic cholecystectomy is one of the most commonly awaited general surgical procedures in the UK. However, many patients awaiting a cholecystectomy are admitted with recurrent gallstone related symptoms while on the waiting list, resulting in significant morbidity. The aim of this study was to quantify this problem, and also to analyse the cost implications of these admissions for the NHS. A retrospective study was performed of all patients who underwent an elective cholecystectomy by three consultants in a district general hospital between January 1999 and January 2000. The demographic details, indications for surgery, details of the emergency admissions while on the waiting list, and the treatment given during these episodes were recorded. One hundred and fifty six patients were included in the study, of which 122 (78%) were females. The mean (SD) age of the patients was 54 (5) years. The mean waiting time for surgery in these patients was 12 (3) months. Thirty seven patients (23.7%) were admitted as an emergency due to gallstone related symptoms and complications while awaiting surgery. There were 47 episodes of admissions in total, of which 32 were for biliary colic, 13 were for acute cholecystitis, and two were for acute pancreatitis. In addition to routine blood tests, 20 abdominal radiographs, 10 chest radiographs, three endoscopic retrograde cholangiopancreatography tests, five ultrasonograms, and one computed tomogram were carried out in these patients. The mean duration of each episode of admission was three days. The cost of treatment per episode was pound 946 and the total cost of treating the 37 patients was calculated to be pound 44 462. Performing early laparoscopic cholecystectomy for acute cholecystitis may help to reduce costs by preventing recurrent emergency admissions in these patients. Further studies to identify risk factors associated with recurrent symptoms and complications in patients with gallstone disease may help to prioritize them for early surgery.
在英国，腹腔镜胆囊切除术是最常被期待的普通外科手术之一。然而，许多等待胆囊切除术的患者在等待名单上时因复发性胆结石相关症状而入院，导致了显著的发病率。本研究的目的是量化这一问题，并分析这些入院情况对英国国民健康服务体系（NHS）的成本影响。对1999年1月至2000年1月期间在一家地区综合医院由三位顾问医生进行择期胆囊切除术的所有患者进行了一项回顾性研究。记录了患者的人口统计学细节、手术指征、等待名单上的紧急入院细节以及这些发作期间接受的治疗。156名患者纳入研究，其中122名（78%）为女性。患者的平均（标准差）年龄为54（5）岁。这些患者的平均手术等待时间为12（3）个月。37名患者（23.7%）在等待手术期间因胆结石相关症状和并发症而急诊入院。总共有47次入院发作，其中32次是因胆绞痛，13次是因急性胆囊炎，2次是因急性胰腺炎。除了常规血液检查外，这些患者还进行了20次腹部X光检查、10次胸部X光检查、3次内镜逆行胰胆管造影检查、5次超声检查和1次计算机断层扫描。每次入院发作的平均持续时间为三天。每次发作的治疗费用为946英镑，37名患者的治疗总成本计算为44462英镑。对急性胆囊炎进行早期腹腔镜胆囊切除术可能有助于通过防止这些患者反复急诊入院来降低成本。进一步研究以确定胆结石疾病患者复发性症状和并发症的相关危险因素，可能有助于将他们列为早期手术的优先对象。
