急性胆囊炎行同期入院腹腔镜胆囊切除术：“黄金72小时”规则是否仍然适用？

Same admission laparoscopic cholecystectomy for acute cholecystitis: is the "golden 72 hours" rule still relevant?

作者信息

Tan Jarrod K H, Goh Joel C I, Lim Janice W L, Shridhar Iyer G, Madhavan Krishnakumar, Kow Alfred W C

机构信息

Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System, Singapore.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

出版信息

HPB (Oxford). 2017 Jan;19(1):47-51. doi: 10.1016/j.hpb.2016.10.006. Epub 2016 Nov 5.

DOI:10.1016/j.hpb.2016.10.006

PMID:27825751

Abstract

BACKGROUND

Studies have shown that same admission laparoscopic cholecystectomy (SALC) is superior to delayed laparoscopic cholecystectomy for acute cholecystitis (AC). While some proposed a"golden 72-hour" for SALC, the optimal timing remains controversial. The aim of the study was to compare the outcomes of SALC in AC patients with different time intervals from symptom onset.

METHODS

A retrospective analysis of 311 patients who underwent SALC for AC from June 2010-June 2015 was performed. Patients were divided into three groups based on the time interval between symptom onset and surgery: <4 days (E-SALC), 4-7 days (M-SALC), >7 (L-SALC).

RESULTS

The mean duration of symptoms was 2(1-3), 5(4-7) and 9 (8-13) days for E-SALC, M-SALC and L-SALC, respectively (p < 0.001). Conversion rates were higher in the L-SALC group [E-SALC, 8.2% vs M-SALC, 9.6% vs L-SALC, 21.4%] (p = 0.048). The total length of stay was longer in patients with longer symptom duration [E-SALC, 4 (2-33) vs M-SALC, 2 (2-23) vs L-SALC, 7 (2-49)] (p < 0.001).

CONCLUSION

Patients with AC presenting beyond 7 days of symptoms have higher conversion rates and longer length of stay associated with SALC. However, patients with less than a week of symptoms should be offered SALC.

摘要

背景

研究表明，对于急性胆囊炎（AC），同期入院腹腔镜胆囊切除术（SALC）优于延迟腹腔镜胆囊切除术。虽然一些人提出SALC的“黄金72小时”，但最佳时机仍存在争议。本研究的目的是比较AC患者在症状发作后不同时间间隔进行SALC的结果。

方法

对2010年6月至2015年6月接受SALC治疗AC的311例患者进行回顾性分析。根据症状发作与手术之间的时间间隔将患者分为三组：<4天（早期SALC，E-SALC），4-7天（中期SALC，M-SALC），>7天（晚期SALC，L-SALC）。

结果

E-SALC、M-SALC和L-SALC的平均症状持续时间分别为2（1-3）天、5（4-7）天和9（8-13）天（p<0.001）。L-SALC组的中转率更高[E-SALC为8.2%，M-SALC为9.6%，L-SALC为21.4%]（p=0.048）。症状持续时间较长的患者总住院时间更长[E-SALC为4（2-33）天，M-SALC为2（2-23）天，L-SALC为7（2-49）天]（p<0.001）。