Department of Surgery, Harbor UCLA Medical Center, Torrance, CA 90509, USA.
Ann Surg. 2010 Apr;251(4):615-9. doi: 10.1097/SLA.0b013e3181c38f1f.
We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis, regardless of resolution of abdominal pain or abnormal laboratory values, would result in a shorter hospital stay.
Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence, the precise timing of laparoscopic cholecystectomy for mild disease remains controversial.
Consecutive patients with mild pancreatitis (Ranson score <or=3) were prospectively randomized to either an early laparoscopic cholecystectomy group (within 48 hours of admission) versus a control laparoscopic cholecystectomy group (performed after resolution of abdominal pain and normalizing trend of laboratory enzymes). The primary end point was hospital length of stay. Secondary end point was a composite of rates of conversion to an open procedure, perioperative complications, and need for endoscopic retrograde cholangiography. The study was designed to enroll 100 patients with an interim analysis after 50 patients.
At interim analysis, 50 patients were enrolled at a single university-affiliated public hospital. Of them, 25 patients were randomized to the early group and 25 patients to the control group. Patient age ranged from 18 to 74 years with a median duration of symptoms of 2 days upon presentation and a median Ranson score of 1. There were no baseline differences between the groups with regards to demographics, clinical presentation, or the presence of comorbidities. The hospital length of stay was shorter for the early cholecystectomy group (mean: 3.5 [95% CI, 2.7-4.3], median: 3 [IQR, 2-4]) compared with the control group (mean: 5.8 [95% CI, 3.8-7.9], median: 4 [IQR, 4-6] [P = 0.0016]). Six patients from the early group required endoscopic retrograde cholangiography, compared with 4 in the control group (P = 0.72). There was no statistically significant difference in the need for conversion to an open procedure or in perioperative complication rates between the 2 groups.
In mild gallstone pancreatitis, laparoscopic cholecystectomy performed within 48 hours of admission, regardless of the resolution of abdominal pain or laboratory abnormalities, results in a shorter hospital length of stay with no apparent impact on the technical difficulty of the procedure or perioperative complication rate.
我们假设对于轻度胆石性胰腺炎，在入院后 48 小时内进行腹腔镜胆囊切除术，无论腹痛是否缓解或实验室值是否异常，都将缩短住院时间。
尽管外科医生普遍认为胆石性胰腺炎患者应行胆囊切除术以预防复发，但轻度疾病的腹腔镜胆囊切除术的确切时机仍存在争议。
连续前瞻性随机分配患有轻度胰腺炎（Ranson 评分≤3）的患者至早期腹腔镜胆囊切除术组（入院后 48 小时内）与对照组腹腔镜胆囊切除术组（腹痛缓解和实验室酶正常化趋势后进行）。主要终点是住院时间。次要终点是中转开腹手术率、围手术期并发症和需要内镜逆行胰胆管造影的复合率。该研究设计招募 100 例患者，在 50 例患者后进行中期分析。
中期分析时，在一家大学附属公立医院入组了 50 例患者。其中，25 例患者被随机分配到早期组，25 例患者分到对照组。患者年龄为 18-74 岁，中位症状持续时间为 2 天，中位 Ranson 评分为 1。两组在人口统计学、临床表现或合并症方面均无基线差异。早期胆囊切除术组的住院时间更短（平均：3.5[95%CI，2.7-4.3]，中位数：3[IQR，2-4]），与对照组相比（平均：5.8[95%CI，3.8-7.9]，中位数：4[IQR，4-6]）[P=0.0016]。早期组有 6 例患者需要内镜逆行胰胆管造影，对照组有 4 例患者需要内镜逆行胰胆管造影（P=0.72）。两组中转开腹手术或围手术期并发症率无统计学差异。
在轻度胆石性胰腺炎中，入院后 48 小时内进行腹腔镜胆囊切除术，无论腹痛是否缓解或实验室异常，都将缩短住院时间，且不会明显影响手术难度或围手术期并发症发生率。
