Peng W K, Sheikh Z, Nixon S J, Paterson-Brown S
Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK.
Br J Surg. 2005 May;92(5):586-91. doi: 10.1002/bjs.4831.
This study evaluated the role of laparoscopic surgery in the early management of acute gallbladder disease in a single large UK teaching hospital.
Details of all emergency admissions for acute gallbladder disease from January 2000 to December 2001 were identified and additional information from the hospital records was reviewed retrospectively.
Three hundred and eighty-five patients with gallstone disease (243 acute biliary pain, 142 acute cholecystitis) and 15 with acalculous disease were identified. The conversion rate was higher during early laparoscopic surgery for acute calculous cholecystitis than in operations for acute biliary pain (19 versus 4 per cent; P = 0.002). In patients with acute calculous cholecystitis the conversion rate was significantly lower in operations within 48 h of admission (one of 26) than when surgery was delayed beyond 48 h (14 of 52) or subsequently carried out electively (seven of 21) (P = 0.014). Elective surgery for previous acute cholecystitis was associated with a higher conversion rate (seven of 21 patients) than elective surgery for biliary pain (three of 65) (P = 0.002).
Laparoscopic cholecystectomy for acute calculous cholecystitis should be performed, where possible, within the first 48 h of admission.
本研究评估了在英国一家大型教学医院中，腹腔镜手术在急性胆囊疾病早期治疗中的作用。
确定了2000年1月至2001年12月期间所有急性胆囊疾病急诊入院患者的详细信息，并回顾性查阅了医院记录中的其他信息。
共识别出385例胆结石疾病患者（243例急性胆绞痛，142例急性胆囊炎）和15例非结石性疾病患者。急性结石性胆囊炎早期腹腔镜手术的中转率高于急性胆绞痛手术（19%对4%；P = 0.002）。在急性结石性胆囊炎患者中，入院48小时内手术的中转率（26例中的1例）显著低于手术延迟超过48小时（52例中的14例）或随后择期手术（21例中的7例）时的中转率（P = 0.014）。既往急性胆囊炎的择期手术中转率（21例患者中的7例）高于胆绞痛择期手术（65例中的3例）（P = 0.002）。
急性结石性胆囊炎的腹腔镜胆囊切除术应尽可能在入院后的头48小时内进行。
