Choi Sae Byeol, Han Hyung Joon, Kim Chung Yun, Kim Wan Bae, Song Tae-Jin, Suh Sung Ock, Kim Young Chul, Choi Sang Yong
Department of Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Gyeonggi-Do, Korea.
Am Surg. 2011 Apr;77(4):401-6.
Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.
由于技术难度和高并发症发生率，腹腔镜胆囊切除术治疗重症急性胆囊炎仍存在争议。我们确定早期腹腔镜胆囊切除术是否适用于急性坏疽性胆囊炎。回顾了2005年1月至2009年12月期间入住韩国大学古罗医院的116例急性坏疽性胆囊炎患者的病历。将早期手术组（诊断后4天内进行胆囊切除术的患者）与延迟手术组（诊断后4天进行胆囊切除术的患者）进行比较。116例患者中，57例在早期手术组，59例在延迟手术组。两组在性别、年龄、体重指数、手术方法、主要并发症、症状持续时间、平均手术时间（98分钟对107分钟）或术后住院时间方面无统计学差异。然而，延迟手术组的总住院时间明显更长。延迟手术组更多患者接受了术前经皮胆囊造瘘术（3.5%对15.3%）。早期腹腔镜胆囊切除术治疗急性坏疽性胆囊炎是安全可行的。对于急性坏疽性胆囊炎患者，推迟紧急手术没有益处。
