Simpson D J, Wood A M, Paterson H M, Nixon S J, Paterson-Brown S
Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.
World J Surg. 2008 Dec;32(12):2690-4. doi: 10.1007/s00268-008-9749-8.
Acute gallstone disease is a common indication for emergency hospital admission, and evidence now strongly supports early laparoscopic cholecystectomy as the treatment of choice. Recent data from the UK suggest that this is achieved in a minority of cases with a high proportion of patients managed by deferred elective surgery or emergency open cholecystectomy. We present results of a policy of definitive treatment during index admission after subspecialist reorganization of a regional emergency surgical service.
Data for all emergency gallstone admissions were retrieved from a prospectively collected regional surgical audit database and results were compared from 31 month periods before and after subspecialist service reorganization in August 2002.
A total of 2442 patients were analyzed. Before subspecialization, 458 of 733 patients (62.4%) underwent cholecystectomy during index admission; after subspecialization, cholecystectomy during index admission for biliary colic/acute cholecystitis was achieved in 666 of 817 (81.5%) patients (90.2% laparoscopic, 6.5% conversion rate, and 3.3% primary open cholecystectomy) with a reduction in hospital stay from median 5 to 4 days. The rate of deferred surgery decreased from 37.5% to 18.4%. Early surgery reduced total hospital admission by more than 1 day per patient compared with deferred surgery.
Early laparoscopic cholecystectomy during emergency admission is cost-effective and should be regarded as the standard of care. However, it requires appropriately trained surgeons and availability of a dedicated emergency room, which at present are not consistently provided in all regions of the UK.
急性胆结石病是急诊入院的常见指征，目前有充分证据支持早期腹腔镜胆囊切除术作为首选治疗方法。英国最近的数据表明，只有少数病例能做到这一点，相当一部分患者接受了延期择期手术或急诊开腹胆囊切除术。我们展示了在区域急诊外科服务进行专科重组后，在首次入院期间进行确定性治疗的一项政策的结果。
从一个前瞻性收集的区域外科审计数据库中检索所有急诊胆结石入院患者的数据，并对2002年8月专科服务重组前后31个月期间的结果进行比较。
共分析了2442例患者。在专科化之前，733例患者中有458例（62.4%）在首次入院期间接受了胆囊切除术；专科化之后，817例胆绞痛/急性胆囊炎患者中有666例（81.5%）在首次入院期间接受了胆囊切除术（90.2%为腹腔镜手术，6.5%为中转率，3.3%为初次开腹胆囊切除术），住院时间从中位数5天减少到4天。延期手术率从37.5%降至18.4%。与延期手术相比，早期手术使每位患者的总住院时间减少了1天以上。
急诊入院时早期进行腹腔镜胆囊切除术具有成本效益，应被视为治疗标准。然而，这需要经过适当培训的外科医生以及配备专门的急诊室，而目前英国并非所有地区都能始终提供这些条件。
