Department of General Surgery, Kayseri City Hospital, Kayseri-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Sep;28(9):1305-1311. doi: 10.14744/tjtes.2021.50241.
In our study, we aimed to compare the complication rates of patients presenting with acute cholecystitis and undergoing surgery at the time of hospitalization (early cholecystectomy) and delayed cholecystectomy and also to examine whether the severity of cholecystitis has an effect on the timing of cholecystectomy.
The study was planned retrospectively and the approval of the ethics committee of our hospital was obtained. The patient files of the patients who were admitted to our tertiary hospital with acute cholecystitis were accessed through the hospital archive system. The patients were divided into two groups, those who were admitted to the emergency department for acute chole-cystitis and who underwent early cholecystectomy and delayed cholecystectomy. The Tokyo 2018 acute cholecystitis guideline was used to determine the severity of acute cholecystitis. Pre-operative and post-operative data of the patients were examined and their complications were evaluated.
The data of 158 patients who met the inclusion criteria were retrospectively analyzed. Compared with delayed chole-cystectomy, complication rates increased in patients who underwent early cholecystectomy (8.1% and 32.2%, respectively, p<0.001). According to the Tokyo 2018 guideline, patients with acute cholecystitis were grouped as Tokyo 1, 2, and 3; and of Tokyo 1 patients, more complications were observed in those who underwent early cholecystectomy (22.6% and 4.2%, respectively, p=0.004). When the complications were examined, it was observed that pulmonary embolism, pneumonia, intra-abdominal abscess development, sepsis, and wound infection were significantly higher in those who were operated early. When the factors affecting complications are examined, having a Tokyo score of 2 and above (OR: 4.161), high creatinine levels (OR: 5.496), and presence of additional disease (OR: 4.238) increase the risk of developing complications.
More complications occur after cholecystectomy in patients with Tokyo 2 and above, when compared with patients with Tokyo 1. It was observed that more complications developed in patients with Tokyo 1 cholecystitis who were operated in the early period. Further studies are needed to determine the effect of acute cholecystitis severity in determining the timing of cholecystectomy.
在我们的研究中，我们旨在比较在住院时（早期胆囊切除术）和延迟胆囊切除术后出现急性胆囊炎并接受手术的患者的并发症发生率，并检查胆囊炎的严重程度是否对胆囊切除术的时间产生影响。
本研究计划采用回顾性方法进行，并获得了我院伦理委员会的批准。通过医院档案系统访问了因急性胆囊炎入院的患者的病历。将患者分为两组，一组因急性胆囊炎入住急诊科并接受早期胆囊切除术，另一组接受延迟胆囊切除术。使用 2018 年东京急性胆囊炎指南确定急性胆囊炎的严重程度。检查患者的术前和术后数据并评估其并发症。
回顾性分析了符合纳入标准的 158 名患者的数据。与延迟胆囊切除术相比，早期胆囊切除术患者的并发症发生率更高（分别为 8.1%和 32.2%，p<0.001）。根据 2018 年东京指南，将急性胆囊炎患者分为东京 1 型、2 型和 3 型；在东京 1 型患者中，早期胆囊切除术的患者并发症更多（分别为 22.6%和 4.2%，p=0.004）。在检查并发症时，发现早期手术的患者肺栓塞、肺炎、腹腔脓肿形成、脓毒症和伤口感染的发生率明显更高。在检查影响并发症的因素时，发现东京评分 2 分及以上（OR：4.161）、肌酐水平升高（OR：5.496）和合并症（OR：4.238）会增加发生并发症的风险。
与东京 1 型患者相比，东京 2 分及以上的患者胆囊切除术后发生的并发症更多。在早期接受手术的东京 1 型胆囊炎患者中，观察到更多的并发症发生。需要进一步研究来确定急性胆囊炎严重程度对胆囊切除术时机的影响。
