Dewana Azhy Muhammed, Namq Amanj Jalal, Ahmed Baderkhan Saeed, Baban Ahmed Abdulkadir
Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
BMC Surg. 2025 May 7;25(1):199. doi: 10.1186/s12893-025-02851-7.
Acute calculus cholecystitis affects 10 to 20% of untreated individuals. Thus, the surgical community has argued for decades over whether an earlier or later cholecystectomy is better for this condition.
To compare surgical results, morbidity, and mortality and determine the best timing for surgical intervention among patients with gallstones.
This prospective cohort study was conducted in Erbil Teaching Hospital, Erbil, Iraq, from January 2013 to December 2023 on 767 patients with acute cholecystitis or symptomatic cholecystolithiasis. Patients underwent various types of cholecystectomy (early, intermediate, late, and elective) based on when surgery was conducted after the onset of symptoms. Then, medical treatments were advised, and they were followed up for six weeks. Finally, patients' physical health, postoperative infection severity and complications were assessed, despite reporting patients' age, gender, operation type, chances of conversions, durations of procedure, and hospital stay.
Most patients were females (72.1%), experienced laparoscopic technique (98.44%), and had ASA II (n = 548, 71.44%). The mean age of patients was 48.40 ± 67.14 years, the mean operation time was 50 ± 30.89 min, and the mean hospitalization time before and after operation was 1.0 ± 0.47 and 2.75 ± 1.63 days, respectively. Most patients from the intermediate group (n = 83) opted for a postponed strategy. Chronic inflammation (grade 0 infection severity) was highest in most patients of the delayed (67.2%) and intermediate groups (53.01%). Most patients had no complications (score 0), and the least had severe complications.
Delayed surgical intervention was harmless and may even be superior to immediate treatment for acute cholecystitis. The morbidity and mortality hazard remains high even in the most severe cases, especially for individuals who received early and intermediate therapy.
急性结石性胆囊炎在未经治疗的患者中发病率为10%至20%。因此，外科界几十年来一直在争论早期或晚期胆囊切除术对这种疾病哪种更好。
比较手术结果、发病率和死亡率，并确定胆结石患者手术干预的最佳时机。
这项前瞻性队列研究于2013年1月至2023年12月在伊拉克埃尔比勒的埃尔比勒教学医院对767例急性胆囊炎或有症状的胆囊结石患者进行。患者根据症状出现后进行手术的时间接受了各种类型的胆囊切除术（早期、中期、晚期和择期）。然后，给予药物治疗，并对他们进行了六周的随访。最后，评估了患者的身体健康状况、术后感染严重程度和并发症，同时记录了患者的年龄、性别、手术类型、中转几率、手术时长和住院时间。
大多数患者为女性（72.1%），采用腹腔镜技术（98.44%），美国麻醉医师协会（ASA）分级为II级（n = 548，71.44%）。患者的平均年龄为48.40±67.14岁，平均手术时间为50±30.89分钟，术前和术后的平均住院时间分别为1.0±0.47天和2.75±1.63天。大多数来自中期组（n = 83）的患者选择了延期策略。延迟组（67.2%）和中期组（53.01%）的大多数患者慢性炎症（感染严重程度为0级）最高。大多数患者无并发症（评分为0），最少的有严重并发症。
延迟手术干预是无害的，甚至可能优于急性胆囊炎的立即治疗。即使在最严重的病例中，发病率和死亡率风险仍然很高，尤其是接受早期和中期治疗的患者。
