McCullough L K, Sutherland F R, Preshaw R, Kim S
Department of Surgery, Faculty of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada.
HPB (Oxford). 2003;5(2):96-9. doi: 10.1080/13651820310001135.
Conventional surgical wisdom is that a patient with gallstone pancreatitis should have the gallbladder removed during their initial hospitalization. However, patients are now often discharged to await operating room availability.
A retrospective review of all cases of gallstone pancreatitis at the Foothills Hospital between 1992 and 1996 was undertaken. Patients with a first attack of mild gallstone pancreatitis were studied.
In all, 164 patients were identified: 90 patients were discharged for readmission cholecystectomy (discharged group), and 74 patients had the cholecystectomy before discharge (in-hospital group). Over the 5-year time period the proportion of patients discharged for readmission cholecystectomy increased from 27% to 67% (p<0.01). The total number of days waited for operation was greater in the discharged group versus in-hospital group: 40+/-69 days versus 8+/-10 days respectively (mean+/-SD). There was a trend towards an increased total number of days in hospital in the in-hospital group, 15.5+/-17 days versus 10.7+/-16 days. In the discharged group 20% (18 of 90) of patients experienced an adverse event requiring readmission while awaiting operation. Three had documented recurrent pancreatitis, 10 experienced recurrent pain, and 5 developed acute cholecystitis. There were no deaths in either group.
Twenty percent of patients with gallstone pancreatitis who are discharged to await operating room time (average wait 40 days) will require readmission for biliary symptoms.
传统外科观点认为，胆石性胰腺炎患者应在首次住院期间切除胆囊。然而，现在患者常常出院等待手术室有空位。
对1992年至1996年期间山麓医院所有胆石性胰腺炎病例进行回顾性研究。研究首次发作轻度胆石性胰腺炎的患者。
共确定164例患者：90例患者出院等待再次入院行胆囊切除术（出院组），74例患者在出院前行胆囊切除术（住院组）。在5年时间里，出院等待再次入院行胆囊切除术的患者比例从27%增至67%（p<0.01）。出院组等待手术的总天数比住院组多：分别为40±69天和8±10天（均值±标准差）。住院组的住院总天数有增加趋势，分别为15.5±17天和10.7±16天。出院组中20%（90例中的18例）患者在等待手术期间发生不良事件需再次入院。3例有复发性胰腺炎记录，10例有复发性疼痛，5例发生急性胆囊炎。两组均无死亡病例。
20%出院等待手术室时间（平均等待40天）的胆石性胰腺炎患者因胆道症状需再次入院。
