Lauro A, Cervellera M, D'Andrea V, Casella Giuseppina, Di Matteo F M, Di Matteo F M, Santoro A, Panarese A, Palazzini G, Cirocchi R, Agastra E, Falvo L, Talarico E, Cicia S, Tonini V
G Chir. 2019 Mar-Apr;40(2):95-104.
The impact of diabetes and cardiovascular comorbidity on laparoscopic cholecystectomy has been long debated, evaluating them as risk factors for conversion to an open procedure especially in patients with acute cholecystitis: an "early" procedure, as suggested by 2013 Tokyo guidelines, has been compared to a "very delayed" one in patients under anticoagulant/antiplatelet therapy or treated for diabetes and referred by medical wards to surgery after the acute period.
We selected 240 patients operated for acute cholecystitis by laparoscopy over the last 4 years at St. Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing 98 diabetic/cardiovascular patients versus 142 subjects as control group: the selection was based on operative timing, "early" (73 patients treated within 3 days) and "very delayed" (167 patients operated after 6 weeks).
In the "early" subgroup there was no difference comparing diabetic/cardiovascular patients (31 pts) versus control group (42 pts) while in the "very delayed" subgroup among diabetic/cardiovascular patients (67 pts) there was significantly male predominance, ASA III/IV prevalence and less positive imaging findings versus control group (100 pts). In both subgroups, the conversion rate was significantly higher for diabetic/cardiovascular patients ("early"=25.8% and "very delayed"=8.95%) compared to control groups ("early"=4.76% and "very delayed"=1%), showing a trend (p=0.058) towards an increased conversion rate in the early approach among diabetic/cardiovascular group.
Our study showed a significantly increased conversion rate to an open cholecystectomy for diabetic/cardiovascular patients affected by cholecystitis, especially within 3 days by the acute episode.
糖尿病和心血管合并症对腹腔镜胆囊切除术的影响一直存在争议，尤其是在急性胆囊炎患者中，评估它们作为转为开腹手术的危险因素：2013年东京指南建议的“早期”手术，已与抗凝/抗血小板治疗患者或糖尿病患者在急性期后由内科病房转诊至外科接受治疗的“非常延迟”手术进行了比较。
我们选择了过去4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腹腔镜急性胆囊炎手术的240例患者，比较98例糖尿病/心血管疾病患者与142例作为对照组的受试者：选择基于手术时机，“早期”（73例在3天内接受治疗）和“非常延迟”（167例在6周后手术）。
在“早期”亚组中，糖尿病/心血管疾病患者（31例）与对照组（42例）相比无差异，而在“非常延迟”亚组中，糖尿病/心血管疾病患者（67例）与对照组（100例）相比，男性占比显著更高，ASA III/IV患病率更高，阳性影像学结果更少。在两个亚组中，糖尿病/心血管疾病患者的中转率（“早期”=25.8%，"非常延迟"=8.95%）显著高于对照组（“早期”=4.76%，"非常延迟"=1%），显示糖尿病/心血管疾病组在早期手术中转率有增加趋势（p=0.058）。
我们的研究表明，受胆囊炎影响的糖尿病/心血管疾病患者转为开腹胆囊切除术的中转率显著增加，尤其是在急性发作后3天内。
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