Leake Pierre-Anthony, Reid Marvin, Plummer Joseph
Department of Surgery, Radiology, Anaesthetics & Intensive Care, University of the West Indies, Mona Campus, Jamaica.
Tropical Metabolic Research Institute, University of the West Indies, Mona Campus, Jamaica.
Ann Med Surg (Lond). 2017 Feb 4;15:37-42. doi: 10.1016/j.amsu.2017.02.001. eCollection 2017 Mar.
High morbidity rates related to cholecystectomy in sickle cell disease (SCD) patients have been previously reported in the region. This study serves to assess the current outcomes related to cholecystectomy in a Jamaican SCD population.
A retrospective chart review of SCD patients undergoing elective cholecystectomy at the University Hospital of the West Indies over a 6-year period was performed providing relevant information for analysis. Patients were grouped on an intention-to-treat basis into an open and laparoscopic group.
A total of 27 patients were included (18 laparoscopic and 9 open). Both groups were matched for age, gender and steady state hemoglobin. Only one patient (in the open group) received preoperative blood transfusion. The conversion rate for laparoscopy was 28%. Operative time was significantly longer in the open group (175.3 ± 62.1 vs. 125.9 ± 54.4 min, p = 0.0355). Bile duct exploration was undertaken in 66.7% of patients in the open group compared to 0% in the laparoscopic group. There was no significant difference between groups with respect to hospital stay, morbidity or mortality. The overall 30-day morbidity was 48.1% with acute chest syndrome being diagnosed in 6 patients and pneumonia in 7 patients.
Morbidity rates related to cholecystectomy in the Jamaican SCD population remain high. Further studies to evaluate the factors contributing to such high morbidity in this population are warranted, with particular focus on laparoscopic cholecystectomy. Strategies such as preoperative transfusion and prophylactic cholecystectomy also need to be evaluated and considered in this patient group.
此前该地区已有报道称镰状细胞病（SCD）患者行胆囊切除术后发病率较高。本研究旨在评估牙买加SCD人群行胆囊切除术后的当前结局。
对西印度群岛大学医院6年间接受择期胆囊切除术的SCD患者进行回顾性病历审查，以提供相关分析信息。患者按意向性治疗原则分为开放手术组和腹腔镜手术组。
共纳入27例患者（18例行腹腔镜手术，9例行开放手术）。两组在年龄、性别和稳态血红蛋白方面相匹配。仅1例患者（开放手术组）接受了术前输血。腹腔镜手术的中转率为28%。开放手术组的手术时间明显更长（175.3 ± 62.1分钟 vs. 125.9 ± 54.4分钟，p = 0.0355）。开放手术组66.7%的患者进行了胆管探查，而腹腔镜手术组为0%。两组在住院时间、发病率或死亡率方面无显著差异。总体30天发病率为48.1%，6例患者被诊断为急性胸综合征，7例患者被诊断为肺炎。
牙买加SCD人群行胆囊切除术后的发病率仍然很高。有必要进一步研究评估导致该人群高发病率的因素，尤其应关注腹腔镜胆囊切除术。术前输血和预防性胆囊切除术等策略也需要在该患者群体中进行评估和考虑。
