Al Salamah Saleh M
Department of Surgery, Riyadh Medical Complex, KSA.
J Coll Physicians Surg Pak. 2005 Jul;15(7):400-3.
To evaluate the outcome of laparoscopic cholecystectomy in acute cholecystitis and to determine various pre-operative risk factors predicting conversion to open cholecystectomy.
Observational study.
Department of Surgery, Riyadh Medical Complex, Riyadh, Saudi Arabia over 5 years period from June 1, 1997 to May 30, 2002.
Consecutive patients admitted with clinical diagnosis of acute cholecystitis confirmed subsequently by abdominal ultrasonography and undergoing laparoscopic cholecystectomy during the same admission. Patients with symptoms of more than one week duration, or various uncontrolled co-morbid conditions requiring optimization before surgery were excluded. Parameters analyzed were morbidity, mortality, incidence and etiology of conversion. Various pre-operative risk factors predicting failure of laparoscopic procedure in acute cholecystitis were further analyzed. Statistical analyses were carried out employing Chi-square test, using IBM-compatible PC, utilizing SPSS 10.0 for Windows (SPSS Inc., Chicago).
Three hundred and eleven patients qualified the inclusion criteria. Mean age was 43.7 years with female to male ratio of 4.5:1. Majority of the patients (91%) were operated within 72 hours of onset of symptoms. Laparoscopic cholecystectomy was successfully accomplished in 86.8 % cases. Out of the 41 converted cases, disturbed anatomy in the region of Calot's triangle was the most common cause of conversion observed in 41.5% patients. Male gender, age more than 65 years, very high leucocyte count, gallbladder wall thickness of more than 4 mm on ultrasonography and complicated disease were observed as most significant determinant for conversion to open procedure. Overall morbidity was 2.9% with no mortality.
Laparoscopic cholecystectomy can be accomplished with minimal morbidity in acute cholecystitis. Knowledge of various factors predicting possible conversion helps in pre-operative selection and counseling for open procedure and early conversion to open technique, with further reduction in the overall morbidity of laparoscopic cholecystectomy.
评估急性胆囊炎行腹腔镜胆囊切除术的结果，并确定预测转为开腹胆囊切除术的各种术前危险因素。
观察性研究。
沙特阿拉伯利雅得利雅得医疗中心外科，1997年6月1日至2002年5月30日的5年期间。
连续收治临床诊断为急性胆囊炎的患者，随后经腹部超声确诊，并在同一住院期间行腹腔镜胆囊切除术。排除症状持续超过一周的患者，或术前需要优化各种未控制的合并症的患者。分析的参数包括发病率、死亡率、转为开腹手术的发生率及病因。进一步分析预测急性胆囊炎腹腔镜手术失败的各种术前危险因素。采用卡方检验进行统计分析，使用与IBM兼容的个人电脑，利用SPSS 10.0 for Windows（SPSS公司，芝加哥）软件。
311例患者符合纳入标准。平均年龄43.7岁，男女比例为4.5:1。大多数患者（91%）在症状出现后72小时内接受手术。86.8%的病例成功完成腹腔镜胆囊切除术。在41例转为开腹手术的病例中，Calot三角区解剖结构紊乱是最常见的转为开腹手术的原因，41.5%的患者出现这种情况。男性、年龄超过65岁、白细胞计数极高、超声显示胆囊壁厚度超过4mm以及复杂疾病被视为转为开腹手术的最显著决定因素。总体发病率为2.9%，无死亡病例。
急性胆囊炎行腹腔镜胆囊切除术可使发病率降至最低。了解预测可能转为开腹手术的各种因素有助于术前选择和咨询开腹手术，并尽早转为开腹技术，从而进一步降低腹腔镜胆囊切除术的总体发病率。
