Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan.
Department of Surgery, Iwate Medical University, Iwate Prefecture, Japan.
JSLS. 2021 Jan-Mar;25(1). doi: 10.4293/JSLS.2020.00116.
The Tokyo Guidelines 2018 have been widely adopted since their publication. However, the few reports on clinical outcomes following laparoscopic cholecystectomy have not taken into account the severity of the acute cholecystitis and the patient's general condition, as estimated by the Charlson comorbidity index. This study aimed to assess the relationships between severity, Charlson comorbidity index, and clinical outcomes subsequent to laparoscopic cholecystectomy.
We extracted the retrospective data for 370 Japanese patients who underwent emergency or scheduled early laparoscopic cholecystectomy within 72 hours from onset between February 2015 and August 2018. We compared postoperative factors in relationship to severity (grade I versus grade II/III). Then, we made a similar comparison between those with low (< 4) and high Charlson comorbidity index (≥ 4).
According to the Tokyo guideline 2018 levels of severity, there were 282 (76.2%), 61 (16.5%), and 27 (7.3%) patients in grades I, II, and III, respectively. With regards to surgical outcomes, the mean operating time was 62.3 minutes and the mean blood loss was 24.4 mL. The mean hospital stay was 3.6 days, with no mortalities. Blood loss was the only factor affected by severity (20.9 mL versus 60.1 mL, = 0.0164), and operating time was the only factor affected by high Charlson comorbidity index (53.4 versus 67.8 minutes, = 0.0153).
Our aggressive strategy is acceptable, and severity and Charlson comorbidity index are not critical factors suggesting the disqualification of early laparoscopic cholecystectomy in patients with any grade acute cholecystitis.
自《东京指南 2018》发布以来，已被广泛采用。然而，少数关于腹腔镜胆囊切除术临床结果的报告并未考虑到急性胆囊炎的严重程度和患者的一般状况，这是由 Charlson 合并症指数来评估的。本研究旨在评估严重程度、Charlson 合并症指数与腹腔镜胆囊切除术后临床结果之间的关系。
我们提取了 2015 年 2 月至 2018 年 8 月期间 370 例日本患者的回顾性数据，这些患者在发病后 72 小时内接受了紧急或择期早期腹腔镜胆囊切除术。我们比较了不同严重程度（I 级与 II/III 级）之间的术后因素。然后，我们比较了 Charlson 合并症指数低（<4）和高（≥4）的患者之间的相似因素。
根据《东京指南 2018》的严重程度分级，I 级、II 级和 III 级患者分别为 282 例（76.2%）、61 例（16.5%）和 27 例（7.3%）。就手术结果而言，平均手术时间为 62.3 分钟，平均出血量为 24.4 毫升。平均住院时间为 3.6 天，无死亡病例。出血量是唯一受严重程度影响的因素（20.9 毫升与 60.1 毫升， = 0.0164），手术时间是唯一受高 Charlson 合并症指数影响的因素（53.4 分钟与 67.8 分钟， = 0.0153）。
我们的积极策略是可以接受的，严重程度和 Charlson 合并症指数并不是任何严重程度急性胆囊炎患者早期腹腔镜胆囊切除术资格的关键因素。
