Al-Mulhim Abdulrahman S, Al-Mulhim Abdulmohsen A
Department of Surgery, King Fahad Hospital, Hofuf, Saudi Arabia.
Surg Endosc. 2009 Jul;23(7):1599-602. doi: 10.1007/s00464-009-0501-8. Epub 2009 May 15.
Sickle cell disease (SCD) is common in the Eastern Province of Saudi Arabia. Patients with this disease have an increased risk for gallstones. Cholecystectomy is the most common general surgical procedure performed in patients with SCD. Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstones. To date, only small series of LC in adults with SCD have been reported. We report a large series of LC in these patients.
A retrospective study included all adults with SCD who underwent LC for symptomatic gallstones at King Fahad Hospital, Hofuf, Saudi Arabia, during a 13-year period. Data analyzed were patient demographics, preoperative blood transfusion, duration of operation, rates of conversion and morbidity, and length of hospital stay.
There were 427 patients; 56% were women with a mean age of 21 years. Blood transfusion was used in 393 patients (92%). Nineteen patients (4.5%) had endoscopic extraction of common bile duct (CBD) stones before LC. Overall, conversion to open surgery was necessary in 21 patients (5%). However, the conversion rate significantly decreased from 9% in the first half of the study to 2% during the second half (p < 0.001). The mean operation time was 76 min. There were 31 complications (7%), mostly related to SCD. There was no mortality, and the mean hospital stay was 2.6 days.
Provided that standard perioperative care is ensured and the procedure is performed by experienced surgeons, LC in adults with SCD results in low rates of conversion and morbidity, no mortality, and a short hospital stay.
镰状细胞病（SCD）在沙特阿拉伯东部省份较为常见。该病患者患胆结石的风险增加。胆囊切除术是SCD患者最常见的普通外科手术。腹腔镜胆囊切除术（LC）是有症状胆结石的标准治疗方法。迄今为止，仅有关于成年SCD患者LC的小样本系列报道。我们报告了这些患者的大样本系列LC情况。
一项回顾性研究纳入了在沙特阿拉伯胡富夫法赫德国王医院13年间因有症状胆结石接受LC的所有成年SCD患者。分析的数据包括患者人口统计学资料、术前输血情况、手术时长、中转率和发病率以及住院时间。
共有427例患者；56%为女性，平均年龄21岁。393例患者（92%）接受了输血。19例患者（4.5%）在LC前接受了内镜下胆总管（CBD）结石取出术。总体而言，21例患者（5%）需要中转开腹手术。然而，中转率从研究前半段的9%显著降至后半段的2%（p < 0.001）。平均手术时间为76分钟。有31例并发症（7%），大多与SCD相关。无死亡病例，平均住院时间为2.6天。
只要确保标准的围手术期护理且由经验丰富的外科医生实施手术，成年SCD患者的LC中转率和发病率较低，无死亡病例，住院时间短。
