Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
Department of Surgery, Zealand University Hospital, Roskilde, Denmark.
Langenbecks Arch Surg. 2019 Aug;404(5):589-597. doi: 10.1007/s00423-019-01802-0. Epub 2019 Jul 11.
In the Danish national guidelines from 2006 on the treatment of acute cholecystitis, early laparoscopic operation within 5 days after the debut of symptoms was recommended. The aim of this study was to analyze the outcome in patients with acute cholecystitis subjected to cholecystectomy in Denmark in the five-year period hereafter.
All patients undergoing cholecystectomy in the period 2006-2010 were registered in the Danish Cholecystectomy Database, from which outcome data were collected. The effect of potential risk factors such as age, gender, BMI, American Society of Anesthesiologists (ASA) score, previous pancreatitis, previous abdominal surgery, year of operation, surgical approach, and surgeon experience was analyzed.
Of 33,853 patients registered with a cholecystectomy, 4667 (14%) were operated for acute cholecystitis. In 95% of the patients, laparoscopic cholecystectomy was intended and in 5% primary open access was chosen. The frequency of conversion from laparoscopic to open surgery was 18%. High age and ASA score, operation in the early years of the period, and open or converted procedure all increased the risk of hospital stay to > 3 days or readmission. High age and ASA score, converted or open operation, and previous pancreatitis increased the risk of additional procedures. Postoperative mortality was 1.2%, and significant risk factors for postoperative death were age, low BMI, high ASA score, early year of operation, and open procedures.
Acute cholecystectomy was safely managed laparoscopically in most patients after the introduction of national guidelines, with an increasing rate of laparoscopically completed procedures during the study period.
在 2006 年丹麦国家急性胆囊炎治疗指南中，建议在症状出现后 5 天内进行早期腹腔镜手术。本研究旨在分析此后五年丹麦行胆囊切除术的急性胆囊炎患者的结局。
在 2006-2010 年期间，丹麦胆囊切除术数据库中登记了所有接受胆囊切除术的患者，并从中收集了结局数据。分析了年龄、性别、BMI、美国麻醉医师协会（ASA）评分、既往胰腺炎、既往腹部手术、手术年份、手术途径和外科医生经验等潜在危险因素的影响。
在登记的 33853 例胆囊切除术患者中，有 4667 例（14%）因急性胆囊炎而行手术。95%的患者计划行腹腔镜胆囊切除术，5%的患者选择初次开腹。腹腔镜转为开腹手术的频率为 18%。高龄和 ASA 评分高、手术在该时期的早期、开腹或中转手术均增加了住院时间>3 天或再次入院的风险。高龄和 ASA 评分高、中转或开腹手术以及既往胰腺炎增加了附加手术的风险。术后死亡率为 1.2%，术后死亡的显著危险因素包括年龄、低 BMI、ASA 评分高、早期手术年份和开腹手术。
在国家指南出台后，大多数患者的急性胆囊切除术可安全地行腹腔镜下完成，在此期间，腹腔镜完成的手术比例逐渐增加。
