Maroske D, Stroh M, Röher H D
Dtsch Med Wochenschr. 1985 Jul 12;110(28-29):1108-14. doi: 10.1055/s-2008-1068968.
Between 1 January 1969 and 30 June 1984 904 patients with acute cholecystitis were treated as inpatients. Including 1976, initial treatment was conservative, and interval operation was recommended after 6-8 weeks. Commencing in 1977 early operation was preferred. Immediate operation within a few hours after admission and preparation for operation was done only in threatening or demonstrable complications of acute cholecystitis. Multimorbidity was highest (39%) in conservatively treated patients (n = 204), it was 26% in immediately operated patients (n = 201) and 23% in patients operated in the interval (n = 199). Early operation (n = 300) was associated with a multimorbidity of only 13%. Postoperative complications occurred most frequently (33%) after immediate operation, and in only 11% after early operation. Exploration of the choledochus was required in 27% of immediately operated cases and in only 19% of early and interval operations. Mortality after exclusively conservative treatment was 3%, after immediate operation 16%, after interval operation 3% and after early operation only 1.3%. Follow-up assessment of 137 primarily non-operated patients (7-15 years) showed a mortality of 48% on subsequently necessary immediate operation (16 out of 33 patients). No symptoms were seen in 14 out of 32 patients, only two of them had no gallstones. The high reliability of establishing the diagnosis (98% correct diagnosis) justifies early operation as preferred concept of treatment. Primary conservative treatment of acute cholecystitis and subsequently planned interval operation should be limited to justifiable exceptions.
1969年1月1日至1984年6月30日期间，904例急性胆囊炎患者接受了住院治疗。包括1976年在内，初始治疗为保守治疗，并建议在6 - 8周后进行择期手术。从1977年开始，更倾向于早期手术。仅在急性胆囊炎出现危及生命或明显并发症时，才在入院后数小时内进行急诊手术并完成手术准备。保守治疗患者（n = 204）的多种疾病并存率最高（39%），急诊手术患者（n = 201）为26%，择期手术患者（n = 199）为23%。早期手术（n = 300）的多种疾病并存率仅为13%。急诊手术后术后并发症发生率最高（33%），而早期手术后仅为11%。急诊手术病例中27%需要探查胆总管，早期手术和择期手术中这一比例仅为19%。单纯保守治疗后的死亡率为3%，急诊手术后为16%，择期手术后为3%，早期手术后仅为1.3%。对137例最初未接受手术的患者进行7 - 15年的随访评估显示，随后因必要的急诊手术导致的死亡率为48%（33例患者中有16例）。32例患者中有14例无症状，其中只有2例没有胆结石。诊断的确立具有高度可靠性（正确诊断率为98%），这证明早期手术作为首选治疗理念是合理的。急性胆囊炎的初始保守治疗及随后计划的择期手术应仅限于合理的例外情况。
