Peters J H, Miller J, Nichols K E, Ollila D, Avrodopolous D
Department of Surgery, University of Southern California, Los Angeles 90033.
Am J Surg. 1993 Sep;166(3):300-3. doi: 10.1016/s0002-9610(05)80978-x.
Laparoscopic cholecystectomy has become the standard of care for the elective management of cholelithiasis. Little information exists, however, regarding the appropriateness of this procedure in the setting of acute symptomatology. We retrospectively reviewed our experience with 516 laparoscopic cholecystectomies performed at a single institution from May 1990 to May 1991. Seventy-five (14.5%) of these patients were admitted from the emergency department with acute abdominal pain (100%), fever (4 of 75, 5%), and/or an elevated white blood cell count (22 of 75, 29%). There were 54 females and 21 males, with a mean age of 50.0 +/- 2.4 years (range: 17 to 89 years). Laparoscopic cholecystectomy was attempted in all patients, and was successful in 68 of 75 patients (91%). Seven procedures were converted to open cholecystectomy because of the difficulty in dissection precluding safe laparoscopic cholecystectomy. The time from admission to surgery (mean: 3.4 +/- 0.3 days), as well as the total hospital stay (mean: 5.5 +/- 0.6 days), was much longer than in the elective circumstance. Mean laboratory values for the group as a whole were as follows: white blood cell count (mean: 9.6 IU/L +/- 0.4 IU/L, range: 4.1 IU/L to 19.5 IU/L), alkaline phosphatase (mean: 97.0 IU/L +/- 13.7 IU/L, range: 27 IU/L to 375 IU/L), and alanine aminotransferase (mean: 78.3 IU/L +/- 13.7 IU/L, range: 15 IU/L to 701 IU/L). Patients requiring open cholecystectomy were older (mean: 61.4 +/- 4.4 versus 48.8 +/- 2.6), were more likely to be febrile (3 of 7, 42%, versus 1 of 68, 1%), and were more likely to have a significant leukocytosis (mean: white blood cell count 12.9 +/- 1.8 x 10(3) cells/mm3 versus 9.2 +/- 0.4 x 10(3) cells/mm3) than were those undergoing successful laparoscopic cholecystectomy. Laparoscopic cholecystectomy can be performed safely in the majority of patients presenting with acute biliary symptoms. Patients with a triad of acute abdominal pain, fever, and elevated white blood cell count, particularly elderly patients, are more likely to require conversion to open cholecystectomy, however.
腹腔镜胆囊切除术已成为择期治疗胆结石的标准术式。然而，关于该手术在急性症状情况下的适用性，相关信息较少。我们回顾性分析了1990年5月至1991年5月在单一机构进行的516例腹腔镜胆囊切除术的经验。其中75例（14.5%）患者因急性腹痛（100%）、发热（75例中的4例，5%）和/或白细胞计数升高（75例中的22例，29%）从急诊科入院。患者中女性54例，男性21例，平均年龄50.0±2.4岁（范围：17至89岁）。所有患者均尝试进行腹腔镜胆囊切除术，75例患者中有68例（91%）成功。7例手术因解剖困难无法进行安全的腹腔镜胆囊切除术而转为开腹胆囊切除术。从入院到手术的时间（平均：3.4±0.3天）以及总住院时间（平均：5.5±0.6天）均比择期手术时长。该组患者的平均实验室检查值如下：白细胞计数（平均：9.6IU/L±0.4IU/L，范围：4.1IU/L至19.5IU/L）、碱性磷酸酶（平均：97.0IU/L±13.7IU/L，范围：27IU/L至375IU/L）和丙氨酸转氨酶（平均：78.3IU/L±13.7IU/L，范围：15IU/L至701IU/L）。需要进行开腹胆囊切除术的患者年龄更大（平均：61.4±4.4岁对48.8±2.6岁），发热的可能性更高（7例中的3例，42%对68例中的1例，1%），且白细胞显著增多的可能性更大（平均：白细胞计数12.9±1.8×10³个/mm³对9.2±0.4×10³个/mm³），高于成功进行腹腔镜胆囊切除术的患者。大多数出现急性胆道症状的患者可以安全地进行腹腔镜胆囊切除术。然而，有急性腹痛、发热和白细胞计数升高三联征的患者，尤其是老年患者，更有可能需要转为开腹胆囊切除术。
