Rosing David K, de Virgilio Christian, Yaghoubian Arezou, Putnam Brant A, El Masry Monica, Kaji Amy, Stabile Bruce E
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
J Am Coll Surg. 2007 Dec;205(6):762-6. doi: 10.1016/j.jamcollsurg.2007.06.291. Epub 2007 Sep 17.
The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes.
An observational study consisting of a retrospective and a prospective group was conducted. For the prospective group, a deliberate policy of early cholecystectomy (less than 48 hours from admission) was used. The primary end point was total length of hospital stay. Secondary endpoints were time from admission to definitive operation, need for endoscopic retrograde cholangiography, and major complications (organ failure and death).
Group I consisted of 177 patients retrospectively reviewed, and Group II was composed of 43 patients prospectively followed. There were no differences between the two groups with respect to demographics. With respect to admission laboratory values, there was a significant difference in median serum amylase, but there were no differences in median serum levels of lipase, total bilirubin, albumin, white blood cell count, or Ranson's score. The median length of hospital stay was 7 days in Group I versus 4 days in Group II (p=or< 0.001). Median time from admission to cholecystectomy was 5 days in Group I versus 2 days in Group II (p=or< 0.0001). Complication rates were similar and there were no deaths in either group.
In patients with mild to moderate gallstone pancreatitis, a policy of early cholecystectomy resulted in a significantly reduced length of hospital stay with no increase in complications or mortality.
胆囊结石性胰腺炎行胆囊切除术的时机仍存在争议。我们推测，对于轻至中度胆囊结石性胰腺炎（Ranson标准为三项及以下）患者，在实验室检查或体格检查异常未消退前尽早行胆囊切除术可缩短住院时间，且不会对预后产生不利影响。
进行了一项由回顾性和前瞻性两组组成的观察性研究。对于前瞻性组，采用了早期胆囊切除术（入院后少于48小时）的明确策略。主要终点是住院总时长。次要终点是从入院到确定性手术的时间、内镜逆行胰胆管造影的需求以及主要并发症（器官衰竭和死亡）。
第一组包括177例进行回顾性分析的患者，第二组由43例进行前瞻性随访的患者组成。两组在人口统计学方面无差异。关于入院时的实验室检查值，血清淀粉酶中位数存在显著差异，但脂肪酶、总胆红素、白蛋白、白细胞计数的血清中位数水平或Ranson评分无差异。第一组的住院中位时长为7天，而第二组为4天（p≤0.001）。第一组从入院到胆囊切除术的中位时间为5天，而第二组为2天（p≤0.0001）。并发症发生率相似，两组均无死亡病例。
对于轻至中度胆囊结石性胰腺炎患者，早期胆囊切除术策略可显著缩短住院时长，且不会增加并发症或死亡率。
