Department of Surgery, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy,
Langenbecks Arch Surg. 2013 Dec;398(8):1129-36. doi: 10.1007/s00423-013-1131-0. Epub 2013 Oct 17.
Early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute cholecystitis (AC), but the optimal surgical timing is controversial. The aim of this study was to retrospectively verify the outcome of patients with AC according to different timing of cholecystectomy.
Patients undergoing cholecystectomy for AC from 2006 to 2012 were stratified into two groups: initial admission cholecystectomy (IAC) and delayed cholecystectomy (DC, after at least 4 weeks). Among IAC, a subgroup undergoing immediate cholecystectomy (IC, within 72 h of symptom onset) was further analyzed.
Three-hundred and sixteen consecutive patients were studied. IAC group included 262 patients (82.9 %) and DC group included 54 patients (17.1 %). The two groups were similar in conversion rate, operation length, and overall complication rate. The total length of hospitalization was longer in DC patients (p = 0.005). Among DC patients, 25.9 % required re-hospitalization while waiting an elective procedure. In the group undergoing IC (66 patients), conversion rate, length of operation, and postoperative morbidity were similar to that of the IAC group. Length of stay was shorter in IC group (p < 0.001). Multivariate analysis identified moderate-severe AC grading and ASA score ≥ 3 as predictors of postoperative complications.
The timing of cholecystectomy for AC does not seem to affect conversion rate and postoperative morbidity. Therefore the 72-h period should not be considered a strict limit to perform LC, provided that the operation is carried out during the initial hospital admission.
早期腹腔镜胆囊切除术（ELC）是急性胆囊炎（AC）的治疗首选，但最佳手术时机仍存在争议。本研究旨在回顾性验证不同胆囊切除术时机对 AC 患者结局的影响。
将 2006 年至 2012 年接受胆囊切除术治疗 AC 的患者分为两组：初次入院胆囊切除术（IAC）和延期胆囊切除术（DC，至少 4 周后）。进一步分析 IAC 中的亚组（即症状发作后 72 小时内进行的即刻胆囊切除术（IC））。
连续研究了 316 例患者。IAC 组包括 262 例患者（82.9%），DC 组包括 54 例患者（17.1%）。两组在中转率、手术时长和总体并发症发生率方面相似。DC 组患者的总住院时间更长（p=0.005）。在 DC 组患者中，25.9%的患者在等待择期手术期间需要再次住院。在接受 IC（66 例）的患者中，中转率、手术时长和术后发病率与 IAC 组相似。IC 组的住院时间更短（p<0.001）。多变量分析确定中重度 AC 分级和 ASA 评分≥3 是术后并发症的预测因素。
AC 行胆囊切除术的时机似乎不会影响中转率和术后发病率。因此，只要在初次住院期间进行手术，72 小时的时间限制不应被视为进行 LC 的严格限制。
