Johansson Mikael, Thune A, Blomqvist A, Nelvin L, Lundell L
Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Gastrointest Surg. 2003 Jul-Aug;7(5):642-5. doi: 10.1016/s1091-255x(03)00065-9.
The aim of this prospective, randomized study was to determine whether laparoscopic cholecystectomy should be performed as an early or a delayed operation in patients with acute cholecystitis. After diagnostic workup, patients were randomized to one of two groups: (1) early laparoscopic cholecystectomy (i.e., within 7 days after onset of symptoms) or (2) initial conservative treatment followed by delayed laparoscopic cholecystectomy 6 to 8 weeks later. Seventy-four patients were placed in the early-operation group, and 71 patients were assigned to the delayed-operation strategy. There was no significant difference in conversion rates (early 31% vs. delayed 29%), operating times (early 98 [range 30 to 355] minutes vs. delayed 100 [45 to 280] minutes), or complications. Failure with the conservative treatment strategy was noted in 26% of these patients. The total hospital stay was significantly shorter in the early group (5 [range 3 to 63] days) vs. the delayed group (8 [range 4 to 50] days; P<0.05). Despite a high conversion rate, early laparoscopic cholecystectomy offered significant advantages in the management of acute cholecystitis compared to a conservative strategy. The greatest advantage was a reduced total hospital stay.
这项前瞻性随机研究的目的是确定急性胆囊炎患者的腹腔镜胆囊切除术应作为早期手术还是延迟手术进行。在完成诊断检查后，患者被随机分为两组：（1）早期腹腔镜胆囊切除术（即症状出现后7天内）或（2）初始保守治疗，随后在6至8周后进行延迟腹腔镜胆囊切除术。74例患者被纳入早期手术组，71例患者被分配到延迟手术策略组。两组在中转率（早期31%对延迟29%）、手术时间（早期98[范围30至355]分钟对延迟100[45至280]分钟）或并发症方面无显著差异。这些患者中有26%的保守治疗策略失败。早期组的总住院时间（5[范围3至63]天）明显短于延迟组（8[范围4至50]天；P<0.05）。尽管中转率较高，但与保守策略相比，早期腹腔镜胆囊切除术在急性胆囊炎的治疗中具有显著优势。最大的优势是总住院时间缩短。
