Cheema S, Brannigan A E, Johnson S, Delaney P V, Grace P A
Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland.
Ir J Med Sci. 2003 Jul-Sep;172(3):128-31. doi: 10.1007/BF02914497.
Laparoscopic cholecystectomy is associated with an increased conversion rate in acute cholecystitis.
To review the operative management of symptomatic cholelithiasis with particular reference to conversion rates and morbidity for laparoscopic cholecystectomy for acute cholecystitis.
Patients undergoing cholecystectomy between January 1994 and December 1998 were recruited. Demographic details, diagnosis, duration of symptoms, treatment, outcome, post-operative stay and complications were recorded.
Complete data were available on 482 patients (84%). Laparoscopic cholecystectomy was attempted in 120 of 132 patients (91%) with acute cholecystitis and 329 of 350 patients (94%) with non-acute gallbladder disease. Conversion rates were 27% (33/120) and 6.7% (22/329) for acute and non-acute gallbladder disease, respectively (p < 0.001 chi2 test). Relating the interval from onset of symptoms to surgery, conversion rates for acute cholecystitis were: < 3 days, 5/17 (29%); 4 to 42 days, 14/59 (23%) and > 42 days, 14/44 (31%). There were three bile duct injuries, two in the delayed (> 45 days) acute group and one in the non-acute group.
Early laparoscopic cholecystectomy is the treatment of choice for acute cholecystitis, but is associated with a high conversion rate independent of the timing of surgery.
腹腔镜胆囊切除术在急性胆囊炎中与较高的中转开腹率相关。
回顾有症状胆结石的手术治疗，特别提及急性胆囊炎腹腔镜胆囊切除术的中转率和发病率。
招募1994年1月至1998年12月期间接受胆囊切除术的患者。记录人口统计学细节、诊断、症状持续时间、治疗、结局、术后住院时间和并发症。
482例患者（84%）有完整数据。132例急性胆囊炎患者中有120例（91%）尝试行腹腔镜胆囊切除术，350例非急性胆囊疾病患者中有329例（94%）尝试行腹腔镜胆囊切除术。急性和非急性胆囊疾病的中转率分别为27%（33/120）和6.7%（22/329）（卡方检验，p<0.001）。将症状出现至手术的间隔时间与中转率相关联，急性胆囊炎的中转率为：<3天，5/17（29%）；4至42天，14/59（23%）；>42天，14/44（31%）。有3例胆管损伤，2例在延迟（>45天）急性组，1例在非急性组。
早期腹腔镜胆囊切除术是急性胆囊炎的首选治疗方法，但与较高的中转率相关，且中转率与手术时机无关。
