Abe Tomoyuki, Kobayashi Tsuyoshi, Kuroda Shintaro, Hamaoka Michinori, Mashima Hiroaki, Onoe Takashi, Honmyo Naruhiko, Oishi Koichi, Ohdan Hideki
Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center, 513, Jike, Saijo-cho, Higashihiroshima, 739-0041, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
BMC Gastroenterol. 2024 Oct 1;24(1):338. doi: 10.1186/s12876-024-03420-7.
Severe acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC.
Data of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into the early cholecystectomy (EC) group (within 72 h of symptom onset) and delayed cholecystectomy (DC) group. They were also subdivided into the upfront cholecystectomy group and preoperative PC before cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared.
No significant differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index between the EC and DC groups were observed. Preoperative drainage was more commonly performed for the DC group than for the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. Compared to the PC before cholecystectomy group, the upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and more patients who used oral warfarin. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays.
Patients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk for postoperative complications; therefore, to prevent AC recurrence during the waiting period, PC before cholecystectomy during the same admission is more appropriate than upfront cholecystectomy for these patients.
重症急性胆囊炎（AC）是一种具有挑战性的疾病，因为它包含并存的全身感染，可导致重要器官功能障碍。本研究评估了重症AC患者术前经皮胆囊造瘘术（PC）的最佳手术时机和疗效。
回顾性收集2011年至2021年间广岛临床肿瘤外科研究组多机构数据库中142例行重症AC胆囊切除术患者的数据。患者分为早期胆囊切除术（EC）组（症状发作72小时内）和延迟胆囊切除术（DC）组。他们还被细分为直接胆囊切除术组和胆囊切除术前术前PC组。根据《2018东京指南》对AC的诊断和严重程度进行分级。比较临床病理变量和结果。
EC组和DC组在年龄、体重指数、美国麻醉医师协会（ASA）分级和Charlson合并症指数方面未观察到显著差异。DC组比EC组更常进行术前引流。DC组比EC组更常检测到局部重症AC特征。EC组和DC组的术后结果具有可比性。与胆囊切除术前PC组相比，直接胆囊切除术组中ASA身体状况≥3的患者更多，使用口服华法林的患者更多。胆囊切除术后PC组的华法林使用率和心血管功能障碍发生率高于直接胆囊切除术组。PC与术中出血显著减少和住院时间缩短相关。
能够耐受全身麻醉的患者是EC的良好候选者。使用华法林的患者和有心血管功能障碍的患者被认为术后并发症风险较高；因此，为防止等待期间AC复发，对于这些患者，在同一住院期间胆囊切除术前进行PC比直接胆囊切除术更合适。
