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我们是否过度检查?低风险腹腔镜胆囊切除术后常规血液检查的反思:一项回顾性研究。

Are We Overtesting? Rethinking Routine Blood Work After Low-Risk Laparoscopic Cholecystectomy: A Retrospective Study.

作者信息

Demir Murat, Kilavuz Huseyin, Gungor Feyyaz, Yaman Sibel, Ekci Baki, Kurtulus Idris

机构信息

Department of General Surgery, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul 34480, Turkey.

出版信息

Medicina (Kaunas). 2025 Aug 29;61(9):1555. doi: 10.3390/medicina61091555.

Abstract

: Laparoscopic cholecystectomy is one of the most performed surgical procedures worldwide. In low-risk patients, routine postoperative blood tests are frequently ordered despite limited evidence supporting their necessity. The aim of the study was to evaluate the predictability of complications that may occur with routine postoperative blood tests. : This retrospective study examined 538 patients who underwent surgery in Cam and Sakura City Hospital between May 2020 and May 2021. Patients were divided into two groups: no postoperative complications (Group NC, n = 521) and postoperative complications (Group C, n = 17). Demographic characteristics, including age and gender, duration of surgery, cystic duct closure method, drain use, complications, preoperative and postoperative blood tests, and the mean time of hospital stay, were the collected data throughout the study. : The analysis of the post-operative blood test values revealed that the total bilirubin ( = 0.005), ALT ( = 0.002), AST ( = 0.002), GGT ( = 0.02) and amylase ( = 0.034) values were statistically significantly higher in Group C than in Group NC, but these values did not exceed the normal range except for ALT, AST and GGT, which were slightly higher than the normal parameters. Seventeen patients (3.15%) developed postoperative complications, including biliary leakage (n = 1); choledocholithiasis (n = 2); cardiac (n = 2), pulmonary (n = 9), and hemorrhagic (n = 2) complications; and a superficial wound infection (n = 1). Most complications were identified by symptoms and clinical observation. : Routine postoperative blood tests in low-risk laparoscopic cholecystectomy patients do not significantly contribute to the early detection of complications. Clinical observation and targeted use of laboratory or imaging tests in selected high-risk cases might be more efficient. This approach can help reduce unnecessary workload, hospital costs, and healthcare expenditures without compromising patient safety.

摘要

腹腔镜胆囊切除术是全球开展最为广泛的外科手术之一。在低风险患者中,尽管支持术后常规血液检查必要性的证据有限,但此类检查仍经常被安排。本研究旨在评估术后常规血液检查可能出现的并发症的可预测性。

这项回顾性研究对2020年5月至2021年5月期间在镰和樱市医院接受手术的538例患者进行了检查。患者分为两组:无术后并发症组(NC组,n = 521)和术后并发症组(C组,n = 17)。在整个研究过程中收集的数据包括人口统计学特征(如年龄和性别)、手术时长、胆囊管闭合方法、引流使用情况、并发症、术前和术后血液检查以及平均住院时间。

对术后血液检查值的分析显示,C组的总胆红素(P = 0.005)、谷丙转氨酶(P = 0.002)、谷草转氨酶(P = 0.002)、γ-谷氨酰转移酶(P = 0.02)和淀粉酶(P = 0.034)值在统计学上显著高于NC组,但除谷丙转氨酶、谷草转氨酶和γ-谷氨酰转移酶略高于正常参数外,这些值均未超过正常范围。17例患者(3.15%)出现术后并发症,包括胆漏(n = 1);胆总管结石(n = 2);心脏(n = 2)、肺部(n = 9)和出血性(n = 2)并发症;以及浅表伤口感染(n = 1)。大多数并发症通过症状和临床观察得以识别。

低风险腹腔镜胆囊切除术患者的术后常规血液检查对并发症的早期检测并无显著贡献。在选定的高风险病例中,临床观察以及有针对性地使用实验室或影像学检查可能更有效。这种方法有助于在不影响患者安全的情况下减少不必要的工作量、医院成本和医疗支出。

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