在急性胆囊炎行急诊腹腔镜胆囊切除术时使用抗血栓治疗并不影响术后结局：一项倾向评分匹配研究。
Taking antithrombic therapy during emergency laparoscopic cholecystectomy for acute cholecystitis does not affect the postoperative outcomes: a propensity score matched study.
机构信息
Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan.
Radiation Biology Branch, National Cancer Institute, 9000 Rockville Pike, Bethesda, Maryland, 20892, USA.
出版信息
BMC Surg. 2022 Feb 5;22(1):42. doi: 10.1186/s12893-022-01501-6.
BACKGROUND
Continuing antithrombic therapy (ATT) during surgery increases the risk of bleeding. However, it is difficult to discontinue the ATT in emergency surgery. Therefore, safety of emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) is still unclear. We aimed to clarify the affect of ATT during emergency LC for AC.
METHODS
Patients with AC were classified into ATT group (n = 30) and non-ATT group (n = 120). Postoperative outcomes were compared after propensity score matching (n = 22).
RESULTS
Higher level of c-reactive protein level and shorter activated partial thromboplastin time (APTT) was observed in ATT group than in non-ATT group after matching. No significant difference was found between other patient characteristics and perioperative results. Blood loss over 100 mL was observed in 8 patients. Multivariate analyze showed that APTT was an independent risk factor for bleeding over 100 mL (P = 0.039), while ACT and APT was not.
CONCLUSIONS
Taking ATT does not affect the blood loss or complications during emergency LC for AC. Controlling intraoperative bleeding is essential for a safe postoperative outcome.
背景
在手术期间继续进行抗血栓治疗（ATT）会增加出血风险。然而，在紧急手术中很难停止 ATT。因此，急性胆囊炎（AC）紧急腹腔镜胆囊切除术（LC）的安全性仍不清楚。我们旨在阐明 ATT 对 AC 紧急 LC 的影响。
方法
将 AC 患者分为 ATT 组（n=30）和非 ATT 组（n=120）。在倾向评分匹配后（n=22）比较术后结果。
结果
匹配后，ATT 组的 C 反应蛋白水平较高，活化部分凝血活酶时间（APTT）较短。其他患者特征和围手术期结果无明显差异。8 例患者出血超过 100 mL。多变量分析表明，APTT 是出血超过 100 mL 的独立危险因素（P=0.039），而 ACT 和 APT 不是。
结论
在 AC 的紧急 LC 期间，ATT 不会影响出血量或并发症。控制术中出血对于安全的术后结果至关重要。
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