Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
BMJ Open Gastroenterol. 2021 Jul;8(1). doi: 10.1136/bmjgast-2021-000705.
The pathogenesis of acute cholangitis (AC) occurs with biliary obstruction followed by bacterial growth in the bile duct. The leading cause of AC is obstructing gallstones. There have been conflicting theories about the optimal timing for cholecystectomy following AC. The aim of this study is to assess the impact of early cholecystectomy on the 30-day readmission rate, 30-day mortality, 90-day readmission rate and the length of hospital stay.
This retrospective study was performed between January 2015 and January 2021 in a high-volume tertiary referral teaching hospital. Included patients were 18 years or older with a definitive diagnosis of acute gallstone cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with complete clearance of the bile duct as an index procedure. We divided the patients into two groups: patients who underwent ERCP alone and those who underwent ERCP with laparoscopic cholecystectomy (LC) on the same admission (ERCP+LC). Data were extracted from electronic medical records. The primary endpoint of the study was the 30-day readmission rate.
A total of 114 patients with AC met the inclusion criteria of the study. The ERCP+LC group had significantly lower rates of 30-day readmission (2.2% vs 42.6%, p<0.001), 90-day readmission (2.2% vs 30.9%, p<0.001) and 30-day mortality (2.2% vs 16.2%, p=0.017) when compared with the ERCP group. In a multivariate logistic regression analysis, patients in the ERCP+LC group had 90% lower odds of 30-day readmission compared with patients who did not undergo LC during admission (OR=0.1, 95% CI (0.032 to 0.313), p<0.001).
Performing LC on same day admission was associated with a decrease in 30-day and 90-day readmission rate as well as 30-day mortality.
急性胆管炎（AC）的发病机制是胆管阻塞后细菌在胆管内生长。AC 的主要原因是阻塞性胆结石。关于 AC 后行胆囊切除术的最佳时机一直存在争议理论。本研究旨在评估早期胆囊切除术对 30 天再入院率、30 天死亡率、90 天再入院率和住院时间的影响。
本回顾性研究于 2015 年 1 月至 2021 年 1 月在一家高容量的三级转诊教学医院进行。纳入标准为年龄 18 岁或以上、经内镜逆行胰胆管造影术（ERCP）确诊为急性胆石性胆管炎并接受完全清除胆管的指数手术。我们将患者分为两组：仅行 ERCP 组和同一入院时行 ERCP 联合腹腔镜胆囊切除术（LC）组（ERCP+LC 组）。从电子病历中提取数据。本研究的主要终点是 30 天再入院率。
共有 114 例 AC 患者符合本研究的纳入标准。ERCP+LC 组 30 天再入院率（2.2%比 42.6%，p<0.001）、90 天再入院率（2.2%比 30.9%，p<0.001）和 30 天死亡率（2.2%比 16.2%，p=0.017）均显著低于 ERCP 组。多变量逻辑回归分析显示，与未行 LC 的患者相比，ERCP+LC 组患者 30 天再入院的可能性降低 90%（OR=0.1，95%CI（0.032 至 0.313），p<0.001）。
在同一入院日行 LC 与降低 30 天和 90 天再入院率以及 30 天死亡率相关。
