Lo C M, Liu C L, Lai E C, Fan S T, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Ann Surg. 1996 Jan;223(1):37-42. doi: 10.1097/00000658-199601000-00006.
The current study compared the results of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis.
Although recent reports have suggested the use of laparoscopic cholecystectomy for acute cholecystitis, the complication and conversion rates remain high. No data are available on whether initial medical treatment can improve the results.
Among 497 patients who underwent laparoscopic cholecystectomy, 52 (10.5%) had a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Twenty-seven of these patients had early surgery, that is, within 120 hours of admission, and 25 had interval cholecystectomy after initial medical treatment.
The early group required modifications in operative technique more frequently (p < 0.001). The conversion rate (7.4%) and minor complication rate (22%) were comparable. Successful early laparoscopic cholecystectomy required a longer operative time (137.2 minutes vs. 98.0 minutes; p < 0.05) and postoperative hospital stay (4.6 days vs. 2.5 days; p < 0.005) but reduced the total hospital stay (6.4 days vs. 12.4 days; p < 0.001).
Early laparoscopic cholecystectomy for the treatment of acute cholecystitis has no adverse effect on complication and conversion rates. Although it is technically demanding and time consuming, this procedure provides the economic advantage of a markedly reduced total hospital stay.
本研究比较早期与延迟腹腔镜胆囊切除术治疗急性胆囊炎的结果。
尽管近期报告建议使用腹腔镜胆囊切除术治疗急性胆囊炎，但其并发症和中转开腹率仍然很高。关于初始内科治疗能否改善治疗结果尚无数据。
在接受腹腔镜胆囊切除术的497例患者中，52例（10.5%）经超声检查临床诊断为急性胆囊炎。其中27例患者接受早期手术，即在入院120小时内进行手术，25例在初始内科治疗后接受择期胆囊切除术。
早期手术组更频繁地需要修改手术技巧（p<0.001）。中转开腹率（7.4%）和轻微并发症发生率（22%）相当。成功的早期腹腔镜胆囊切除术需要更长的手术时间（137.2分钟对98.0分钟；p<0.05）和术后住院时间（4.6天对2.5天；p<0.005），但缩短了总住院时间（6.4天对12.4天；p<0.001）。
早期腹腔镜胆囊切除术治疗急性胆囊炎对并发症和中转开腹率无不良影响。尽管该手术技术要求高且耗时，但能显著缩短总住院时间，具有经济优势。
