Jung Bo-Hyun, Park Jeong-Ik
Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Ann Hepatobiliary Pancreat Surg. 2017 Feb;21(1):21-29. doi: 10.14701/ahbps.2017.21.1.21. Epub 2017 Feb 28.
BACKGROUNDS/AIMS: Frequently encountered in practice, the first-line treatment for acute cholecystitis is early or urgent cholecystectomy, with laparoscopic cholecystectomy (LC) being the preferred method. Percutaneous transhepatic gallbladder drainage (PTGBD) is considered as a safe alternative therapeutic option for resolving acute cholecystitis in surgically high-risk patients. We evaluated the surgical outcomes of acute cholecystitis, focusing on the differences between emergent LC without PTGBD, and scheduled LC following PTGBD.
Between March 2010 and December 2014, 294 patients with acute cholecystitis who had undergone LC, were retrospectively studied. Group I included 166 patients who underwent emergency LC without PTGBD. Group II included 128 patients who underwent scheduled LC after PTGBD. Clinical outcomes were analyzed according to each group.
On admission, Group II had a higher mean level of c-reactive protein than Group I. According to the classification of the American Society of Anesthesiologists (ASA), group II had a greater number of high-risk patients than group I. There was no significant difference on perioperative outcomes between the two groups, including open conversion rate and complications. Analysis as per the ASA classes revealed no statistically remarkable finding between the groups.
There are no significant differences in the surgical outcomes of emergency LC group without PTGBD, and scheduled LC group following PTGBD. Comparison between two groups according to ASA classification reflecting the comorbidity and severity of condition of the patients also revealed no significant differences. However, scheduled LC following PTGBD is important for patients having acute cholecystitis with concurrent comorbidity.
背景/目的：在临床实践中，急性胆囊炎的一线治疗方法通常是早期或急诊胆囊切除术，其中腹腔镜胆囊切除术（LC）是首选方法。经皮经肝胆管胆囊引流术（PTGBD）被认为是一种安全的替代治疗选择，用于解决手术高危患者的急性胆囊炎。我们评估了急性胆囊炎的手术结果，重点关注未行PTGBD的急诊LC与PTGBD后择期LC之间的差异。
回顾性研究了2010年3月至2014年12月期间接受LC的294例急性胆囊炎患者。第一组包括166例未行PTGBD的急诊LC患者。第二组包括128例PTGBD后择期LC的患者。根据每组情况分析临床结果。
入院时，第二组的C反应蛋白平均水平高于第一组。根据美国麻醉医师协会（ASA）分类，第二组的高危患者数量多于第一组。两组围手术期结果无显著差异，包括开放手术转换率和并发症。按ASA分级分析显示两组之间无统计学显著差异。
未行PTGBD的急诊LC组与PTGBD后择期LC组的手术结果无显著差异。根据反映患者合并症和病情严重程度的ASA分类对两组进行比较也未发现显著差异。然而，PTGBD后择期LC对合并急性胆囊炎的患者很重要。
