Mercer S J, Knight J S, Toh S K C, Walters A M, Sadek S A, Somers S S
Department of Upper Gastrointestinal Surgery, Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
Br J Surg. 2004 Apr;91(4):504-8. doi: 10.1002/bjs.4458.
The 'gold standard' treatment for acute cholecystitis and biliary colic requiring hospital admission is urgent laparoscopic cholecystectomy. This is not routinely available in all hospitals.
A retrospective audit of emergency admissions with acute cholecystitis or biliary colic from January to December 2000 led to the development and implementation of a specialist-led protocol for the urgent management of acute gallstone disease. A second audit was carried out covering the 6 months after implementation.
One hundred and fifty-eight patients were admitted with acute cholecystitis or biliary colic in the first audit period and 110 in the second interval. The rate of cholecystectomy at index admission increased from 37.3 to 67.3 per cent, at a median of 3 days after admission, and the conversion rate to open surgery fell from 32 to 12 per cent. Median hospital stay fell from 9 to 5.5 days, and the unplanned readmission rate decreased from 19.0 to 3.6 per cent.
Urgent cholecystectomy for the management of acute gallstone disease is feasible and achievable in an acute services hospital with a specialist upper gastrointestinal team. It can lead to a reduced conversion rate, shorter hospital stay, fewer unplanned readmissions, an acceptable operating time and a low complication rate. The protocol is recommended for implementation in other hospitals.
对于需要住院治疗的急性胆囊炎和胆绞痛，“金标准”治疗方法是急诊腹腔镜胆囊切除术。但并非所有医院都能常规开展此项手术。
对2000年1月至12月因急性胆囊炎或胆绞痛急诊入院的病例进行回顾性审计，据此制定并实施了由专科医生主导的急性胆石症紧急处理方案。在方案实施后的6个月进行了第二次审计。
第一次审计期间有158例患者因急性胆囊炎或胆绞痛入院，第二次审计期间有110例。首次入院时胆囊切除术的实施率从37.3%提高到67.3%，入院后中位时间为3天，开腹手术的转化率从32%降至12%。中位住院时间从9天降至5.5天，非计划再入院率从19.0%降至3.6%。
在拥有专科上消化道团队的急症医院，对急性胆石症进行急诊胆囊切除术是可行且可实现的。这可降低转化率、缩短住院时间、减少非计划再入院次数、使手术时间可接受且并发症发生率低。建议在其他医院实施该方案。
