Botaitis S, Pitiakoudis M, Perente S, Tripsianis G, Polychronidis A, Simopoulos C
Second Department of Surgery, Democritus University of Thrace, Greece.
S Afr J Surg. 2012 Jul 11;50(3):62, 64, 68. doi: 10.7196/sajs.1284.
Laparoscopic cholecystectomy (LC) is increasingly being used as the initial surgical approach in patients with acute cholecystitis (AC). We describe our experience with LC in the treatment of AC.
In this study 2 412 patients underwent LC, in 315 cases for AC. The diagnosis was based on clinical, laboratory and intra-operative findings. Rates of conversion, complications, length of hospital stay, operating times, and factors associated with conversion or morbidity were analysed.
Conversion to open cholecystectomy was necessary in 60 patients (19.04%) with AC. Factors associated with conversion were age >65 years, male gender, presence of empyema, previous abdominal surgery, and fever (temperature >37.5oC). There were no deaths, and the complication rate was 6.4%. The only risk factor for morbidity was a bilirubin level of >20.52 µmol/l. The operating time and hospital stay were significantly longer in AC than in elective cases.
LC for AC is technically demanding but safe and effective. With patience, experience, careful dissection and identification of vital structures, the laparoscopic approach is safe in the majority of cases.
腹腔镜胆囊切除术（LC）越来越多地被用作急性胆囊炎（AC）患者的初始手术方法。我们描述了我们在LC治疗AC方面的经验。
本研究中2412例患者接受了LC，其中315例为AC。诊断基于临床、实验室及术中发现。分析了中转率、并发症、住院时间、手术时间以及与中转或发病相关的因素。
60例（19.04%）AC患者需要中转开腹胆囊切除术。与中转相关的因素包括年龄>65岁、男性、存在积脓、既往腹部手术以及发热（体温>37.5℃）。无死亡病例，并发症发生率为6.4%。发病的唯一危险因素是胆红素水平>20.52µmol/l。AC患者的手术时间和住院时间明显长于择期手术患者。
LC治疗AC技术要求高，但安全有效。凭借耐心、经验、仔细的解剖以及对重要结构的识别，腹腔镜手术方法在大多数情况下是安全的。
