Ohta Masayuki, Iwashita Yukio, Yada Kazuhiro, Ogawa Tadashi, Kai Seiichiro, Ishio Tetsuya, Shibata Kohei, Matsumoto Toshifumi, Bandoh Toshio, Kitano Seigo
Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
JSLS. 2012 Jan-Mar;16(1):65-70. doi: 10.4293/108680812X13291597716023.
In patients with acute cholecystitis who cannot undergo early laparoscopic cholecystectomy (within 72 hours), 6 weeks to 12 weeks after onset is widely considered the optimal timing for delayed laparoscopic cholecystectomy. However, there has been no clear consensus about it. We aimed to determine optimal timing for delayed laparoscopic cholecystectomy for acute cholecystitis.
Medical records of 100 patients who underwent standard laparoscopic cholecystectomy were reviewed retrospectively. Patients were divided into group 1, patients undergoing laparoscopic cholecystectomy within 72 hours of onset; group 2, between 4 days to 14 days; group 3, between 3 weeks to 6 weeks; group 4, >6 weeks.
No significant differences existed between groups in conversion rate to open surgery, operation time, blood loss, or postoperative morbidity, and hospital stay. However, total hospital stay in groups 1 and 2 was significantly shorter than that in groups 3 and 4 (P<.01). In addition, the total hospital stay in group 3 was also significantly shorter than that in group 4 (P<.01).
Best timing of laparoscopic cholecystectomy for acute cholecystitis may be within 72 hours, and the delayed timing of laparoscopic cholecystectomy in patients who cannot undergo early laparoscopic cholecystectomy is probably as soon as possible after they can tolerate laparoscopic cholecystectomy.
对于无法早期（72小时内）行腹腔镜胆囊切除术的急性胆囊炎患者，发病6周-12周后被广泛认为是延迟腹腔镜胆囊切除术的最佳时机。然而，对此尚无明确共识。我们旨在确定急性胆囊炎延迟腹腔镜胆囊切除术的最佳时机。
回顾性分析100例行标准腹腔镜胆囊切除术患者的病历。患者分为1组，发病72小时内行腹腔镜胆囊切除术；2组，发病4天至14天；3组，发病3周-6周；4组，发病>6周。
各组间转为开腹手术的比例、手术时间、失血量、术后发病率及住院时间无显著差异。然而，1组和2组的总住院时间显著短于3组和4组（P<0.01）。此外，3组的总住院时间也显著短于4组（P<0.01）。
急性胆囊炎腹腔镜胆囊切除术的最佳时机可能在72小时内，对于无法早期行腹腔镜胆囊切除术的患者，延迟腹腔镜胆囊切除术的时机可能是在其能够耐受腹腔镜胆囊切除术后尽快进行。
