急性胆囊炎早期腹腔镜胆囊切除术的时机
Timing of early laparoscopic cholecystectomy for acute cholecystitis.
作者信息
Al-Mulhim Abdulmohsen A
机构信息
Department of Surgery, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
出版信息
JSLS. 2008 Jul-Sep;12(3):282-7.
OBJECTIVE
Although many surgeons advocate early laparoscopic cholecystectomy (LC) in acute cholecystitis, debate still exists regarding its optimal timing. This study compares the outcome of LC performed within and after 72 hours of admission in patients with acute cholecystitis.
METHODS
Between January 2001 and December 2006, LC was performed in 196 consecutive patients with acute cholecystitis. Laparoscopic cholecystectomy was performed within 72 hours of admission in 82 patients (group 1) and after 72 hours in 114 patients (group 2). Data were collected prospectively.
RESULTS
Both groups were matched in terms of age, sex, body mass index, fever, white blood cell count, and ultrasound findings. The overall conversion rate was 5%. No significant difference existed in conversion rates between group 1 (2.4%) and group 2 (7%) (P=0.3). The operation time (105 versus 126 minutes, P=0.008), complications (0% versus 6%, P=0.02), and total hospital stay (5 versus 12 days, P<0.001) were significantly reduced in group 1. No deaths occurred in this study.
CONCLUSION
Early LC can be performed safely in most patients with acute cholecystitis, but we recommend intervention within 72 hours of admission to minimize the complication rate and shorten the operation time and total hospital stay.
目的
尽管许多外科医生主张在急性胆囊炎时早期行腹腔镜胆囊切除术（LC），但其最佳时机仍存在争议。本研究比较了急性胆囊炎患者入院72小时内及之后行LC的结果。
方法
2001年1月至2006年12月，连续196例急性胆囊炎患者接受了LC。82例患者（第1组）在入院72小时内行腹腔镜胆囊切除术，114例患者（第2组）在72小时后行该手术。前瞻性收集数据。
结果
两组在年龄、性别、体重指数、发热、白细胞计数和超声检查结果方面相匹配。总体中转率为5%。第1组（2.4%）和第2组（7%）的中转率无显著差异（P = 0.3）。第1组的手术时间（105分钟对126分钟，P = 0.008）、并发症（0%对6%，P = 0.02）和总住院时间（5天对12天，P < 0.001）均显著降低。本研究中无死亡病例。
结论
大多数急性胆囊炎患者可安全地早期行LC，但我们建议在入院72小时内进行干预，以降低并发症发生率，缩短手术时间和总住院时间。
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