El-Gendi Ahmed, El-Shafei Mohamed, Emara Doaa
Department of Surgery, Faculty of Medicine, Alexandria University, El Sultan Hussein Street, El-Azarita, Khartom Square, Alexandria, 21131, Egypt.
Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Gastrointest Surg. 2017 Feb;21(2):284-293. doi: 10.1007/s11605-016-3304-y. Epub 2016 Oct 24.
In grade II acute cholecystitis patients presenting more than 72 h after onset of symptoms, we prospectively compared treatment with emergency (ELC) to delayed laparoscopic cholecystectomy performed 6 weeks after percutaneous transhepatic gallbladder drainage (PTGBD).
Four hundred ninety-five patients with acute cholecystitis were assessed for eligibility; 345 were excluded or declined to participate. One hundred fifty patients were treated after consent with either ELC or PTGBD.
Both PTGBD and ELC were able to resolve quickly cholecystitis sepsis. ELC patients had a significantly higher conversion rate (24 vs. 2.7 %, P < 0.001), longer mean operative time (87.8 ± 33.06 vs. 38.09 ± 8.23 min, P < 0.001), higher intraoperative blood loss (41.73 ± 51.09 vs. 26.33 ± 23.86, P = 0.008), and longer duration of postoperative hospital stay (51.71 ± 49.39 vs. 10.76 ± 5.75 h, P < 0.001) than those in the PTGBD group. Postoperative complications were significantly more frequent in the ELC group (26.7 vs. 2.7 %, P < 0.001) with a significant increase in incidence (10.7 %) of bile leak (P = 0.006) compared to those in the PTGBD group.
CONCLUSION(S): PTGBD and ELC are highly efficient in resolving cholecystitis sepsis. Delayed cholecystectomy after PTGBD produces better outcomes with a lower conversion rate, fewer procedure-related complications, and a shorter hospital stay than emergency cholecystectomy.
在症状出现超过72小时的II级急性胆囊炎患者中，我们前瞻性地比较了急诊腹腔镜胆囊切除术（ELC）与在经皮经肝胆囊引流术（PTGBD）6周后进行的延迟腹腔镜胆囊切除术的治疗效果。
对495例急性胆囊炎患者进行资格评估；345例被排除或拒绝参与。150例患者在获得同意后接受了ELC或PTGBD治疗。
PTGBD和ELC均能迅速解决胆囊炎脓毒症。与PTGBD组相比，ELC组患者的中转率显著更高（24%对2.7%，P<0.001），平均手术时间更长（87.8±33.06分钟对38.09±8.23分钟，P<0.001），术中失血量更多（41.73±51.09对26.33±23.86，P=0.008），术后住院时间更长（51.71±49.39小时对10.76±5.75小时，P<0.001）。ELC组术后并发症明显更常见（26.7%对2.7%，P<0.001），与PTGBD组相比，胆漏发生率显著增加（10.7%）（P=0.006）。
PTGBD和ELC在解决胆囊炎脓毒症方面效率很高。与急诊胆囊切除术相比，PTGBD后延迟胆囊切除术具有更好的效果，中转率更低，与手术相关的并发症更少，住院时间更短。
