Department of Trauma and Emergency Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
Surg Endosc. 2012 Nov;26(11):3301-6. doi: 10.1007/s00464-012-2344-y. Epub 2012 May 31.
Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC.
From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBD followed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups.
A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3.
Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation.
胆囊穿孔是胆囊炎的一种罕见但严重的并发症。通常采用经皮胆囊引流（PTGBD）联合择期胆囊切除术进行治疗。然而，越来越多的证据表明，在这种情况下早期腹腔镜胆囊切除术（LC）仍然可行。我们假设早期 LC 可能与 PTGBD+择期 LC 的手术结果相当。
回顾性分析 2005 年 1 月至 2011 年 10 月期间因诊断为穿孔性胆囊炎而入住中国医科大学附属医院的患者。通过影像学和/或术中发现诊断为胆囊穿孔。排除那些血流动力学不稳定不适合全身麻醉或同时进行主要手术的患者。患者分为三组：早期开腹胆囊切除术（组 1）、早期 LC（组 2）和 PTGBD 联合择期 LC（组 3）。分析和比较了三组患者的人口统计学特征、手术结果和患者预后。
共纳入 74 例患者。除了组 2 的患者更年轻（62 岁与 72 岁和 73.5 岁相比，p = 0.016）外，所有患者的人口统计学特征相似。三组患者的手术时间、失血量、中转率和并发症发生率均无差异。与组 1 和组 3 相比，组 2 患者的住院时间（LOS）明显缩短。
虽然 PTGBD 联合择期 LC 仍然是治疗胆囊穿孔的主要方法，但早期 LC 与 PTGBD+LC 的手术结果相当，但 LOS 明显缩短。早期 LC 应被视为胆囊穿孔的最佳治疗方法，PTGBD+LC 可保留用于手术风险较高的患者。
