腹腔镜胆囊切除术治疗急性胆囊炎：早期和延迟胆囊切除术的结局和成本比较。

Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy.

机构信息

Department of Surgical Sciences, Organ Transplantation and Advances Technologies, University of Catania, Catania, Italy.

出版信息

Eur Rev Med Pharmacol Sci. 2014 Dec;18(2 Suppl):40-6.

PMID:25535191

Abstract

BACKGROUND

Several trials showed that early laparoscopic cholecystectomy is superior to delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis. However actual practice does not conform to current evidence. The aim of this study is to compare outcomes and total hospital costs between early and delayed laparoscopic cholecystectomy for acute cholecystitis.

PATIENTS AND METHODS

A retrospective analysis of patients with acute cholecystitis that underwent a laparoscopic cholecystectomy at our institutions was performed. Patients were divided into 2 groups on the basis of the treatment received and statistical analysis was performed.

RESULTS

The study included 91 patients, 52 female and 39 male, with a mean age of 55. Early surgery was performed in 32 cases and delayed surgery in 59 cases. The two groups were comparable for demographics data and severity of disease on admission. There was a no significant difference (p = 0.174) in the mean operative time between early (54.8 min) and delayed group (47.8 min). Conversion rate was higher in the early group (34.3% vs. 20.3%), but difference was not statistically significant (p = 0.223). The overall complications rate was comparable (18.7% early vs. 16.9% delayed, p = 0.941). Length of postoperative stay (4.3 vs. 3.8 days) was similar (p = 0.437), but total hospital stay was significantly 4 days shorter in the early group (p < 0.0001). The mean total cost was higher for the delayed group (4171 vs. 6041), with a significant difference of 1870 Euro (p < 0.0001).

CONCLUSIONS

Early laparoscopic cholecystectomy has an outcome comparable to the delayed procedure, with a shorter total hospital stay and lower total costs, and it should be considered as the preferred approach in treatment of acute cholecystitis.

摘要

背景

多项试验表明，对于急性胆囊炎的治疗，早期腹腔镜胆囊切除术优于延迟腹腔镜胆囊切除术。然而，实际情况并不符合现有证据。本研究旨在比较早期和延迟腹腔镜胆囊切除术治疗急性胆囊炎的结果和总住院费用。

患者和方法

对在我们机构接受腹腔镜胆囊切除术的急性胆囊炎患者进行回顾性分析。根据治疗方法将患者分为两组，并进行统计学分析。

结果

研究共纳入 91 例患者，其中女性 52 例，男性 39 例，平均年龄为 55 岁。早期手术 32 例，延迟手术 59 例。两组在人口统计学数据和入院时疾病严重程度方面具有可比性。早期组（54.8 分钟）和延迟组（47.8 分钟）的平均手术时间无显著差异（p=0.174）。早期组的中转率较高（34.3%比 20.3%），但差异无统计学意义（p=0.223）。总的并发症发生率相似（早期组 18.7%，延迟组 16.9%，p=0.941）。术后住院时间（4.3 天比 3.8 天）相似（p=0.437），但早期组的总住院时间明显缩短 4 天（p<0.0001）。延迟组的总费用较高（4171 欧元比 6041 欧元），差异显著为 1870 欧元（p<0.0001）。