Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Ishikawa, 921-8162, Japan; Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Department of Surgery, Japanese Red Cross Kanazawa Hospital, Kanazawa, Ishikawa, 921-8162, Japan.
Asian J Surg. 2021 Jan;44(1):280-285. doi: 10.1016/j.asjsur.2020.07.002. Epub 2020 Jul 21.
/Objective: We evaluated the risk of acute cholangitis and/or cholecystitis while waiting for cholecystectomy for gallstones.
We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after conservative therapy. We compared clinical data of 20 patients who developed acute cholangitis and/or cholecystitis while waiting for cholecystectomy (group A) with 148 patients who did not develop (group B). We investigated surgical outcomes and risk factors for developing acute cholangitis and/or cholecystitis.
Preoperatively, significant numbers of patients with previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p < 0.001) and biliary drainage (20.0% vs 2.0%; p = 0.004) were observed between groups A and B. White blood cell counts (13500/μL vs 8155/μL; p < 0.001) and C-reactive protein levels (12.6 vs 5.1 mg/dL; p < 0.001) were significantly higher in group A than in group B; albumin levels (3.2 vs 4.0 g/dL; p < 0.001) were significantly lower in group A. Gallbladder wall thickening (≥5 mm) (45.0% vs 18.9%; p = 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p = 0.005), and peri-gallbladder abscess (20.0% vs 1.4%; p = 0.002) were significantly more frequent in group A than in group B. A higher conversion rate to open surgery (20.0% vs 2.0%; p = 0.004), longer operation time (137 vs 102 min; p < 0.001), and higher incidence of intraoperative complications (10.0% vs 0%; p = 0.014) were observed in group A, compared with group B.
A history of severe cholecystitis may be a risk factor for acute cholangitis and/or cholecystitis in patients waiting for surgery; it may also contribute to increased surgical difficulty.
目的：评估胆石症患者等待胆囊切除期间发生急性胆管炎和/或胆囊炎的风险。
我们回顾性纳入了 168 例接受胆囊切除术治疗胆石症的患者。我们比较了 20 例在等待胆囊切除期间发生急性胆管炎和/或胆囊炎的患者（A 组）与未发生的 148 例患者（B 组）的临床资料。我们研究了手术结果和发生急性胆管炎和/或胆囊炎的危险因素。
术前，A 组中有更多的患者有既往重度急性胆囊炎（Ⅱ级或Ⅲ级）病史（55.0%比 10.8%；p<0.001）和胆道引流史（20.0%比 2.0%；p=0.004）。A 组的白细胞计数（13500/μL 比 8155/μL；p<0.001）和 C 反应蛋白水平（12.6 比 5.1mg/dL；p<0.001）显著高于 B 组，白蛋白水平（3.2 比 4.0g/dL；p<0.001）显著低于 B 组。A 组的胆囊壁增厚（≥5mm）（45.0%比 18.9%；p=0.018）、胆囊颈部嵌顿结石（55.0%比 22.3%；p=0.005）和胆囊周围脓肿（20.0%比 1.4%；p=0.002）的发生率显著高于 B 组。与 B 组相比，A 组的中转开腹率（20.0%比 2.0%；p=0.004）、手术时间（137 比 102min；p<0.001）和术中并发症发生率（10.0%比 0%；p=0.014）更高。
重度胆囊炎病史可能是患者等待手术时发生急性胆管炎和/或胆囊炎的危险因素，也可能增加手术难度。
