Zargar-Shoshtari Kamran, Short Heather, Poole Garth H, Hill Andrew G
Department of Surgery, Middlemore Hospital, Auckland, New Zealand.
ANZ J Surg. 2008 Sep;78(9):771-4. doi: 10.1111/j.1445-2197.2008.04647.x.
Early laparoscopic cholecystectomy has been shown to be the treatment of choice for acute presentations of gallstone disease. However, currently this practice is not common in many centres. The aim of the study was to evaluate surgical management of patients presenting with acute symptomatic gallstone disease to Middlemore Hospital in 2005.
A retrospective case review of acute presentations of symptomatic gallstone disease was carried out between 1 January and 31 December 2005.
Four hundred and two patients were included in the final analysis. Forty-six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 25 declined surgery. Therefore, 305 patients (76%) were eligible for surgery at index admission (IA). Two hundred and four (67%) received surgery during IA with a median time to surgery of 3 days. From the 198th patient who did not have acute surgery at IA, 112 had delayed surgery. When comparing those with surgery at IA with those who did not receive surgery at IA, median length of stay for IA was significantly longer in acute surgical group (5 vs 3 P = 0.05); however, there was no significant difference in duration of total hospital stay (6 vs 6 P > 0.05). For those who had acute surgery the conversion rate was 3% (six) compared with 7% (seven) in delayed surgery group (P = 0.09).
Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and effective.
早期腹腔镜胆囊切除术已被证明是治疗胆结石疾病急性发作的首选方法。然而，目前这种做法在许多中心并不常见。本研究的目的是评估2005年在米德尔莫尔医院就诊的有症状胆结石疾病急性发作患者的手术治疗情况。
对2005年1月1日至12月31日期间有症状胆结石疾病急性发作的病例进行回顾性研究。
最终分析纳入了402例患者。其中46例患者不适合手术，26例仅入住急诊科而未转诊至手术团队，25例拒绝手术。因此，305例患者（76%）在首次入院时符合手术条件。204例（67%）在首次入院时接受了手术，手术中位时间为3天。在首次入院时未进行急诊手术的198例患者中，112例接受了延迟手术。将首次入院时接受手术的患者与未接受手术的患者进行比较，急性手术组首次入院的中位住院时间明显更长（5天对3天，P = 0.05）；然而，总住院时间没有显著差异（6天对6天，P > 0.05）。对于接受急诊手术的患者，中转率为3%（6例），而延迟手术组为7%（7例）（P = 0.09）。
急诊手术仍然是急性胆道疾病的首选治疗方法。这种方法需要一个坚定的团队协作，但安全有效。
