Department of Visceral Surgery and Medicine, Inselspital, University Hospital Berne and University of Berne, CH-3010 Berne, Switzerland.
Ann Surg. 2011 Dec;254(6):964-70. doi: 10.1097/SLA.0b013e318228d31c.
To compare clinical outcomes after laparoscopic cholecystectomy (LC) for acute cholecystitis performed at various time-points after hospital admission.
Symptomatic gallstones represent an important public health problem with LC the treatment of choice. LC is increasingly offered for acute cholecystitis, however, the optimal time-point for LC in this setting remains a matter of debate.
Analysis was based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery and included patients undergoing emergency LC for acute cholecystitis between 1995 and 2006, grouped according to the time-points of LC since hospital admission (admission day (d0), d1, d2, d3, d4/5, d ≥6). Linear and generalized linear regression models assessed the effect of timing of LC on intra- or postoperative complications, conversion and reoperation rates and length of postoperative hospital stay.
Of 4113 patients, 52.8% were female, median age was 59.8 years. Delaying LC resulted in significantly higher conversion rates (from 11.9% at d0 to 27.9% at d ≥6 days after admission, P < 0.001), surgical postoperative complications (5.7% to 13%, P < 0.001) and re-operation rates (0.9% to 3%, P = 0.007), with a significantly longer postoperative hospital stay (P < 0.001).
Delaying LC for acute cholecystitis has no advantages, resulting in significantly increased conversion/re-operation rate, postoperative complications and longer postoperative hospital stay. This investigation-one of the largest in the literature-provides compelling evidence that acute cholecystitis merits surgery within 48 hours of hospital admission if impact on the patient and health care system is to be minimized.
比较不同入院时间行腹腔镜胆囊切除术（LC）治疗急性胆囊炎的临床转归。
有症状的胆囊结石是一个重要的公共卫生问题，LC 是其治疗的首选方法。LC 越来越多地用于治疗急性胆囊炎，但在这种情况下，LC 的最佳时机仍存在争议。
分析基于瑞士腹腔镜和胸腔镜外科协会的前瞻性数据库，纳入 1995 年至 2006 年间因急性胆囊炎行急诊 LC 的患者，根据入院后行 LC 的时间点（入院日（d0）、d1、d2、d3、d4/5、d≥6）分组。线性和广义线性回归模型评估了 LC 时机对围手术期并发症、中转率和再手术率以及术后住院时间的影响。
4113 例患者中，52.8%为女性，中位年龄为 59.8 岁。LC 时间延迟与中转率显著升高相关（从入院后 d0 的 11.9%增加到 d≥6 的 27.9%，P＜0.001）、手术相关并发症（从 5.7%增加到 13%，P＜0.001）和再手术率（从 0.9%增加到 3%，P=0.007），且术后住院时间显著延长（P＜0.001）。
急性胆囊炎行 LC 时间延迟并无优势，反而会显著增加中转/再手术率、术后并发症和术后住院时间。这项研究是文献中最大规模之一，提供了强有力的证据表明，为了减轻对患者和医疗系统的影响，急性胆囊炎应在入院后 48 小时内进行手术。
