Inoue Koetsu, Ueno Tatsuya, Douchi Daisuke, Shima Kentaro, Goto Shinji, Takahashi Michinaga, Morikawa Takanori, Naitoh Takeshi, Shibata Chikashi, Naito Hiroo
Department of surgery, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan.
Department of surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
BMC Surg. 2017 Nov 28;17(1):114. doi: 10.1186/s12893-017-0319-6.
The Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC.
Totally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed.
In univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979-19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126-20.15; p = 0.0009) were independent risk factors for difficulty of LC.
In patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients.
《2013东京指南》将急性胆囊炎（AC）分为三个等级，并针对每个等级推荐了适当的治疗方法。对于II级AC，应行早期腹腔镜胆囊切除术（LC）或经皮经肝胆管胆囊引流术（PTGBD）。本研究旨在确定II级AC行LC困难的危险因素。
共纳入122例行II级AC的LC患者，分为LC困难组（DLC）和非LC困难组（NDLC）。DLC组包括经历以下情况之一的患者：由LC转为开腹胆囊切除术、手术时间≥180分钟或失血≥300毫升。分析术前特征和术后结果。
单因素分析显示，危险因素包括男性、症状出现至入院间隔时间、症状出现至LC间隔时间以及抗凝治疗。DLC组术后并发症发生率高于NDLC组（23.5%对4.6%，p = 0.0016）。根据受试者工作特征曲线计算最佳截断值，多因素分析显示男性[比值比（OR），5.76；95%置信区间（CI），1.979 - 19.51；p = 0.0009]和症状出现至LC间隔时间超过96小时（OR，6.32；95% CI，2.126 - 20.15；p = 0.0009）是LC困难的独立危险因素。
在II级AC患者中，症状出现后超过96小时行LC技术上困难。此外，男性是一个危险因素。因此，这些患者应考虑行PTGBD。
