St. Elizabeth Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135, USA.
Surg Endosc. 2012 Oct;26(10):2779-83. doi: 10.1007/s00464-012-2278-4. Epub 2012 Apr 27.
The objective of this study was to analyze a population-based database for (1) recent 9-year trends in utilization of partial cholecystectomy (PC), laparoscopic PC, and trocar cholecystostomy (TC), (2) demographics, associated diagnoses, and hospital characteristics, and (3) relevant inpatient outcomes.
Retrospective cohort analysis of the Nationwide Inpatient Sample (NIS) files from 2000 to 2008 was performed. For the purposes of the study, gallbladder damage control was defined as PC, laparoscopic PC, and TC.
A national estimate of 10,872 gallbladder damage control cases was obtained. Procedures performed included PC (47.8 %), laparoscopic PC (27.2 %), TC (25.3 %), and intraoperative cholangiogram (IOC) (19.7 %). A total of 1,479 (13.6 %) postoperative complications were identified, including pulmonary complications (4.3 %), hemorrhage/hematoma/seroma (3.4 %), and accidental puncture or laceration during procedure (3.3 %). Common bile duct injury occurred in 3.3 % overall. Hospital types included nonteaching (82.1 %) and urban (67.8 %), with regional variations of 42.1 % from the South and 45.2 % from the West. Inpatient outcomes included mean length of stay of 11.4 (0.16 SEM) days, mean total hospital charge of $71,296.69 ($1,106.03 SEM), 7.4 % mortality, and 16.8 % discharge to skilled nursing facility. Multivariate logistic regression analysis identified independent risk variables for common bile duct injury: teaching hospitals (OR = 1.517, CI = 1.155-1.991, P = 0.003). IOC (OR = 2.030, CI = 1.590-2.591, P < 0.001) was a commonly associated procedure in the setting of common bile duct injury.
Various circumstances may require gallbladder damage control with PC and TC. Postoperative complications and common bile duct injury remain significantly high despite limited resection, and the teaching status of the hospital is associated with CBD injury. High morbidity and mortality of gallbladder damage control may reflect both the compromised nature of the procedures and multiple comorbidities.
本研究的目的是分析基于人群的数据库，以了解（1）近年来部分胆囊切除术（PC）、腹腔镜 PC 和经皮胆囊造口术（TC）的利用趋势，（2）人口统计学、相关诊断和医院特征，以及（3）相关住院结果。
对 2000 年至 2008 年全国住院患者样本（NIS）文件进行回顾性队列分析。为了研究目的，胆囊损伤控制定义为 PC、腹腔镜 PC 和 TC。
获得了全国范围内 10872 例胆囊损伤控制病例的估计值。实施的手术包括 PC（47.8%）、腹腔镜 PC（27.2%）、TC（25.3%）和术中胆管造影术（IOC）（19.7%）。共发现 1479 例（13.6%）术后并发症，包括肺部并发症（4.3%）、出血/血肿/血清肿（3.4%）和手术过程中意外穿刺或撕裂（3.3%）。总胆管损伤发生率为 3.3%。医院类型包括非教学医院（82.1%）和城市医院（67.8%），南部地区占 42.1%，西部地区占 45.2%。住院结果包括平均住院时间 11.4 天（0.16 SEM）、平均总住院费用 71296.69 美元（1106.03 SEM）、7.4%的死亡率和 16.8%的患者出院至康复护理机构。多变量逻辑回归分析确定了总胆管损伤的独立风险变量：教学医院（OR=1.517，CI=1.155-1.991，P=0.003）。IOC（OR=2.030，CI=1.590-2.591，P<0.001）是总胆管损伤发生时常见的相关手术。
各种情况下可能需要进行 PC 和 TC 以进行胆囊损伤控制。尽管进行了有限的切除，但术后并发症和总胆管损伤仍然明显较高，医院的教学状态与 CBD 损伤有关。胆囊损伤控制的高发病率和死亡率可能反映了这些手术的局限性和多种合并症。
