腹腔镜胆囊切除术治疗急性胆囊炎：预期手术方式、时机和结局是否受体重指数影响？一项多中心回顾性研究。

Laparoscopic cholecystectomy for acute cholecystitis: are intended operative approach, timing and outcome affected by BMI? A multicenter retrospective study.

作者信息

Lauro A, Vaccari S, Cervellera M, Casella Giuseppina, D'Andrea V, Di Matteo F M, Panarese A, Santoro A, Cirocchi R, Tonini V

出版信息

G Chir. 2018 Mar-Apr;39(2):87-91.

PMID:29694307

Abstract

BACKGROUND

Laparoscopy is the gold-standard for cholecystectomy after acute cholecystitis, but the issue is controversial in obese subjects.

PATIENTS AND METHODS

We reviewed 464 patients operated for acute cholecystitis (59 open and 405 laparoscopic) over the last five years at St Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing retrospectively: 1) BMI < 30 (397 patients) and BMI =/> 30 (67 patients) and moreover 2) BMI < 25 (207 patients) and BMI =/> 25 (257 patients).

RESULTS

In the first comparison, obese patients showed higher cardiovascular co-morbidity (61.1% vs 44.5%, p=0.01), worse symptoms (Murphy's sign positive in 92.5% vs 80.8%, p=0.02; fever >38.5°C in 88.0% vs 76.0 %, p=0.02) and significant radiologic imaging (95.5% vs 85.1%, p=0.01) of acute cholecystitis. Laparoscopy was used in 83.6% of obese patients vs 87.9% without any difference, and operative time or conversion rate were similar. According to Tokyo Guidelines 2013, the number of patients who underwent surgery within 3 days or after 6 weeks was similar without statistical difference between the two groups. Hospital stay, morbidity and mortality were similar. Complications were seen in 25.4% of obese patients vs 15.9% (p= 0.03), mainly represented by wound infections. The second comparison did show no difference between two groups BMI =/>25 and BMI < 25.

CONCLUSIONS

Our retrospective multicenter study showed no difference related to intended operative approach, timing and outcome in higher BMI versus lower BMI patients operated for acute cholecystitis.

摘要

背景

腹腔镜检查是急性胆囊炎胆囊切除术后的金标准，但在肥胖患者中该问题存在争议。

患者与方法

我们回顾了过去五年在博洛尼亚圣奥索拉大学医院和罗马翁贝托一世大学医院接受急性胆囊炎手术的464例患者（59例开腹手术和405例腹腔镜手术），进行回顾性比较：1）体重指数（BMI）<30（397例患者）和BMI≥30（67例患者），此外2）BMI<25（207例患者）和BMI≥25（257例患者）。

结果

在首次比较中，肥胖患者心血管合并症发生率更高（61.1%对44.5%，p = 0.01），症状更严重（墨菲氏征阳性率92.5%对80.8%，p = 0.02；发热>38.5°C的比例88.0%对76.0%，p = 0.02），急性胆囊炎的影像学表现更明显（95.5%对85.1%，p = 0.01）。83.6%的肥胖患者接受了腹腔镜检查，非肥胖患者为87.9%，无差异，手术时间或中转开腹率相似。根据2013年东京指南，两组在3天内或6周后接受手术的患者数量相似，无统计学差异。住院时间、发病率和死亡率相似。肥胖患者并发症发生率为25.4%，非肥胖患者为15.9%（p = 0.03），主要为伤口感染。第二次比较显示BMI≥25和BMI<25的两组之间无差异。