Khan Iftikhar A, El-Tinay Omer E
Division of General Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2004 Mar;25(3):299-302.
To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure.
Retrospective analysis of 44 laparoscopic cholecystectomies were performed for acute cholecystitis between August 2000 and July 2002 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temperature, white blood cell count, gallbladder wall thickness on ultrasonography and timing of surgery from onset of symptoms were collected.
The procedure was converted from laparoscopic to open cholecystectomy in 10 patients (23%). Conversion rate was significantly high (33% versus zero; p=0.01) if the gallbladder wall was thickened. Conversion rate was significantly low (zero versus 32%: p=0.01) if the procedure was performed within 48 hours from the onset of symptoms. The data related to age, sex, white blood cell count and body temperature did not reliably predict conversion of laparoscopic cholecystectomy for acute cholecystitis to open procedure. There was no mortality or major morbidity.
Laparoscopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonography and delay in surgery for more than 48 hours from the onset of symptoms.
确定术前临床、实验室及放射学数据能否预测急性胆囊炎腹腔镜胆囊切除术中转开腹手术的情况。
回顾性分析2000年8月至2002年7月在沙特阿拉伯利雅得国王哈立德大学医院进行的44例急性胆囊炎腹腔镜胆囊切除术。收集患者的年龄、性别、最高体温、白细胞计数、超声检查显示的胆囊壁厚度以及从症状发作至手术的时间等数据。
10例患者（23%）手术由腹腔镜胆囊切除术中转开腹胆囊切除术。若胆囊壁增厚，中转率显著升高（33%对0；p = 0.01）。若在症状发作后48小时内进行手术，中转率显著降低（0对32%：p = 0.01）。与年龄、性别、白细胞计数及体温相关的数据不能可靠地预测急性胆囊炎腹腔镜胆囊切除术中转开腹手术的情况。无死亡或严重并发症发生。
腹腔镜胆囊切除术是治疗急性胆囊炎的一种安全术式。与中转率增加相关的因素是超声检查显示胆囊壁增厚以及症状发作后手术延迟超过48小时。
