Department of Surgery, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, Korea,
Surg Endosc. 2013 Oct;27(10):3776-80. doi: 10.1007/s00464-013-2968-6. Epub 2013 May 4.
With the accumulating experience in laparoscopic surgery, early laparoscopic cholecystectomy (LC) is increasingly offered for acute cholecystitis. However, early LC without percutaneous transhepatic gallbladder drainage (PTGBD) for gallbladder empyema is still believed to be unsafe. The purpose of this study was to determine the optimal time for LC in gallbladder empyema.
A retrospective analysis was carried out of patients who underwent LC without PTGBD for gallbladder empyema between August 2007 and December 2010. All cases were confirmed by biopsy. The patients were divided into two groups on the basis of a cutoff of 72 h.
LC for gallbladder empyema was performed without PTGBD in 61 patients during the study period. The overall conversion rate was 6.6 %. Based on the 72 h cutoff, there were 33 patients in the early group and 28 in the delayed group. There were no significant differences between early and late patients with respect to operation duration (75.5 vs. 71.4 min, p = 0.537), postoperative hospital stay (4.2 vs. 3.3 days, p = 0.109), conversion rate (12.1 vs. 0 %, p = 0.118), and complication rate (12.1 vs. 3.6 %, p = 0.363). However, the early group had a significantly shorter total hospital stay (5.3 vs. 8.7 days, p = 0.001).
Early LC without PTGBD is safe and feasible for gallbladder empyema and is associated with a low conversion rate. Delayed LC for gallbladder empyema has no advantages and results in longer total hospital stays. LC should be performed as soon as possible within 72 h after admission to decrease length of hospital stay.
随着腹腔镜手术经验的积累，越来越多的医生选择对急性胆囊炎患者进行早期腹腔镜胆囊切除术（LC）。然而，对于胆囊积脓，不先行经皮经肝胆囊引流术（PTGBD）而直接行早期 LC 仍被认为是不安全的。本研究旨在确定胆囊积脓行 LC 的最佳时机。
回顾性分析 2007 年 8 月至 2010 年 12 月期间因胆囊积脓而行 LC 且未行 PTGBD 的患者。所有病例均经活检证实。根据 72 小时的时间截点，将患者分为两组。
研究期间，61 例胆囊积脓患者行 LC 且未行 PTGBD，总体中转开腹率为 6.6%。根据 72 小时的时间截点，早期组 33 例，延迟组 28 例。两组患者的手术时间（75.5 分钟 vs. 71.4 分钟，p=0.537）、术后住院时间（4.2 天 vs. 3.3 天，p=0.109）、中转开腹率（12.1% vs. 0%，p=0.118）和并发症发生率（12.1% vs. 3.6%，p=0.363）均无统计学差异。然而，早期组的总住院时间明显更短（5.3 天 vs. 8.7 天，p=0.001）。
对于胆囊积脓，不先行 PTGBD 而直接行早期 LC 是安全可行的，且中转开腹率较低。延迟行 LC 对于胆囊积脓并无优势，反而会导致总住院时间延长。LC 应在入院后 72 小时内尽快进行，以缩短住院时间。
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