德国一家三级保健医院在 COVID-19 大流行期间进行腹腔镜胆囊切除术：老年患者中急性和坏疽性胆囊炎的发生率更高。
Laparoscopic cholecystectomy during the COVID-19 pandemic in a tertiary care hospital in Germany: higher rates of acute and gangrenous cholecystitis in elderly patients.
机构信息
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
出版信息
BMC Surg. 2022 May 10;22(1):168. doi: 10.1186/s12893-022-01621-z.
BACKGROUND
The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany.
PATIENTS AND METHODS
We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year.
RESULTS
A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the "pandemic subgroup". Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality.
CONCLUSION
Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.
背景
2020 年的 COVID-19 大流行引发了全球卫生危机。这场大流行也对普通外科的标准程序产生了负面影响。外科医生面临着为急性胆囊炎患者寻找最佳治疗方案的挑战。本研究旨在调查 COVID-19 大流行对德国一家三级保健医院行腹腔镜胆囊切除术的结果的影响。
患者和方法
我们检查了 2020 年 3 月 22 日（德国首次全国封锁）至 2020 年 12 月 31 日期间行腹腔镜胆囊切除术的患者的围手术期结果。然后，我们将这些结果与前一年同期的围手术期结果进行了比较。
结果
共纳入了在此期间行腹腔镜胆囊切除术的 182 名患者。大流行组有 100 例，对照组有 82 例。对老年患者（>65 岁）的亚组分析显示，大流行组急性胆囊炎（5 [17.9%] vs. 20 [58.8%]；p=0.001）和坏疽性胆囊炎（0 [0.0%] vs. 7 [20.6%]；p=0.013）的发生率明显更高。此外，在这个亚组中，早期胆囊切除术的比例也明显更高[5 (17.9%) vs. 20 (58.8%)；p=0.001]。在总体和亚组分析中，两组在手术时间、术中出血量、住院时间、发病率和死亡率方面均无显著差异。
结论
在大流行期间，老年患者的急性和坏疽性胆囊炎发生率尤其高。在 COVID-19 时代，可以安全地进行腹腔镜胆囊切除术，而不会对围手术期结果产生负面影响。因此，我们认为对于任何患有急性胆囊炎的患者，包括老年人，都可以推荐行腹腔镜胆囊切除术。
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