Uchiyama Kazuhisa, Onishi Hironobu, Tani Masaji, Kinoshita Hiroyuki, Ueno Masaki, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):346-8.
BACKGROUND/AIMS: Laparoscopic cholecystectomy is now used in the treatment of acute cholecystitis. The aim of this study is to define the optimal timing for laparoscopic cholecystectomy treated with cholecystolithiasis in patients with acute cholecystitis.
A retrospective analysis of 73 patients with acute cholecystolithiasis who were treated by either early laparoscopic cholecystectomy within 72 hours after initial onset or initial conservative treatment followed by delayed laparoscopic cholecystectomy 4 days later.
There were 31 patients in the early group and 42 in the delayed group. There was no significant difference in the rate of conversion from laparoscopic to open surgery (6.4% vs. 20.0%), postoperative complications. However the early group had significantly shorter operation time (103 vs. 135 min, p<0.01) and shorter postoperative hospital stay (6.2 vs. 9.6 days, p<0.01).
We advocate early laparoscopic cholecystectomy within 72 hours of onset of symptoms to decrease conversion rates from laparoscopic to open surgery. This decreased conversion rate results in decreasing the length of operation time and postoperative and total hospital stay.
背景/目的：腹腔镜胆囊切除术目前用于治疗急性胆囊炎。本研究的目的是确定急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术的最佳时机。
回顾性分析73例急性胆囊结石患者，这些患者要么在初次发病后72小时内行早期腹腔镜胆囊切除术，要么先进行初始保守治疗，4天后再行延迟腹腔镜胆囊切除术。
早期组有31例患者，延迟组有42例患者。腹腔镜手术转为开腹手术的比例（6.4% 对20.0%）、术后并发症方面无显著差异。然而，早期组的手术时间显著更短（103分钟对135分钟，p<0.01），术后住院时间也更短（6.2天对9.6天，p<0.01）。
我们提倡在症状出现72小时内行早期腹腔镜胆囊切除术，以降低腹腔镜手术转为开腹手术的比例。这种降低的转换率可缩短手术时间、术后住院时间和总住院时间。
