Chan Kai Siang, Baey Samantha, Shelat Vishal G, Junnarkar Sameer P
Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Hepatobiliary Pancreat Dis Int. 2024 Dec;23(6):586-594. doi: 10.1016/j.hbpd.2023.08.002. Epub 2023 Aug 3.
Emergency index-admission cholecystectomy (EIC) is recommended for acute cholecystitis in most cases. General surgeons have less exposure in managing "difficult" cholecystectomies. This study aimed to compare the outcomes of EIC between hepatopancreatobiliary (HPB) versus non-HPB surgeons.
This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022. Patients who underwent open cholecystectomy, had previous cholecystitis, previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded. A 1:1 propensity score matching (PSM) was performed to adjust for confounding variables (e.g. age ≥ 75 years, history of abdominal surgery, presence of dense adhesions).
There were 1409 patients (684 HPB cases, 725 non-HPB cases) in the unmatched cohort. Majority (52.3%) of them were males with a mean age of 59.2 ± 14.9 years. Among 472 (33.5%) patients with EIC performed ≥ 72 hours after presentation, 40.1% had dense adhesion. The incidence of any morbidity, open conversion, subtotal cholecystectomy and bile duct injury were 12.4%, 5.0%, 14.6% and 0.1%, respectively. There was one mortality within 30 days from EIC. PSM resulted in 1166 patients (583 per group). Operative time was shorter when EIC was performed by HPB surgeons (115.5 vs. 133.4 min, P < 0.001). The mean length of hospital stay was comparable. EIC performed by HPB surgeons was independently associated with lower open conversion [odds ratio (OR) = 0.24, 95% confidence interval (CI): 0.12-0.49, P < 0.001], lower fundus-first cholecystectomy (OR = 0.58, 95% CI: 0.35-0.95, P = 0.032), but higher subtotal cholecystectomy (OR = 4.19, 95% CI: 2.24-7.84, P < 0.001). Any morbidity, bile duct injury and mortality were comparable between the two groups.
EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion. However, the incidence of subtotal cholecystectomy was higher.
在大多数情况下，建议对急性胆囊炎进行急诊指数入院胆囊切除术（EIC）。普通外科医生在处理“困难”胆囊切除术方面经验较少。本研究旨在比较肝胰胆（HPB）外科医生与非HPB外科医生进行EIC的结果。
这是一项对2011年12月至2022年3月期间接受EIC的患者进行的为期10年的回顾性审计。排除接受开腹胆囊切除术、既往有胆囊炎、既往有内镜逆行胰胆管造影术或胆囊造瘘术的患者。进行1:1倾向评分匹配（PSM）以调整混杂变量（如年龄≥75岁、腹部手术史、存在致密粘连）。
在未匹配队列中有1409例患者（684例HPB病例，725例非HPB病例）。其中大多数（52.3%）为男性，平均年龄为59.2±14.9岁。在就诊后≥72小时进行EIC的472例（33.5%）患者中，40.1%有致密粘连。任何并发症、中转开腹、次全胆囊切除术和胆管损伤的发生率分别为12.4%、5.0%、14.6%和0.1%。EIC后30天内有1例死亡。PSM后有1166例患者（每组583例）。HPB外科医生进行EIC时手术时间较短（115.5对133.4分钟，P<0.001）。平均住院时间相当。HPB外科医生进行EIC与较低的中转开腹独立相关[比值比（OR）=0.24，95%置信区间（CI）：0.12 - 0.49，P<0.001]，较低的先处理胆囊底部胆囊切除术（OR = 0.58，95%CI：0.35 - 0.95，P = 0.032），但次全胆囊切除术较高（OR = 4.19，95%CI：2.24 - 7.84，P<0.001）。两组之间的任何并发症、胆管损伤和死亡率相当。
HPB外科医生进行的EIC与较短的手术时间和降低的中转开腹风险相关。然而，次全胆囊切除术的发生率较高。
