Farooq Tahir, Buchanan Gordon, Manda Vijay, Kennedy Robin, Ockrim Jonathan
Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, United Kingdom.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):471-4. doi: 10.1089/lap.2008.0363.
Early laparoscopic cholecystectomy (ELC) in acute cholecystitis improves hospital stay and outcome. Operative difficulty is said to increase with delay, and surgery is usually advised within 3 days of presentation. It can be difficult to accommodate all these patients within 3 days; this study evaluates results within and after this "safe period."
In total, 137 patients (male:female 45:92) presenting as an emergency due to acute cholecystitis over 45 months from August 1, 2003, who then underwent ELC with an on-table cholangiogram (OTC) or laparoscopic ultrasound were prospectively studied. Outcome was compared between those who underwent surgery within 72 hours (group 1) or after 72 hours (group 2).
There were 87 patients in group 1 versus 50 in group 2. There was no significant difference with reference to ASA grading, length of operation (median 90 vs. 90 minutes; P = 1.000), conversion rates (7 vs. 10%; P = 0.523), median postoperative stay (2 vs. 3 days; P = 0.203), or 30-day readmission rates [5/87 [6%] vs. 3/50 [6%]; P = 1.000] between groups, respectively. There was no mortality. One patient had a biliary leak from a duct of Lushka in group 2, which settled after endoscopic stenting.
In experienced hands, ELC is safe even after 72 hours.
急性胆囊炎早期腹腔镜胆囊切除术（ELC）可改善住院时间和治疗效果。据说手术难度会随着时间延迟而增加，通常建议在发病后3天内进行手术。在3天内收治所有这些患者可能会有困难；本研究评估了在这个“安全期”内及之后的治疗结果。
对2003年8月1日起45个月内因急性胆囊炎作为急诊就诊的137例患者（男:女为45:92）进行前瞻性研究，这些患者随后接受了术中胆管造影（OTC）或腹腔镜超声检查的ELC。比较了在72小时内接受手术的患者（第1组）和72小时后接受手术的患者（第2组）的治疗结果。
第1组有87例患者，第2组有50例患者。两组在ASA分级、手术时长（中位数90分钟对90分钟；P = 1.000）、中转率（7%对10%；P = 0.523）、术后中位住院时间（2天对3天；P = 0.203）或30天再入院率[5/87（6%）对3/50（6%）；P = 1.000]方面均无显著差异。无死亡病例。第2组有1例患者来自卢氏管的胆漏，在内镜下置入支架后得到解决。
在经验丰富的医生手中，即使在72小时后进行ELC也是安全的。
