Koo K P, Thirlby R C
Department of Surgery, Virginia Mason Medical Center, Seattle, Wash., USA.
Arch Surg. 1996 May;131(5):540-4; discussion 544-5. doi: 10.1001/archsurg.1996.01430170086016.
To review the results of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis with attention to cost and clinical outcome.
Retrospective study.
Large private metropolitan teaching hospital.
Four hundred forty-six patients had LCs at our institution between January 1993 and February 1995. Acute cholecystitis, confirmed by clinical, laboratory, operative, and histopathological findings, was present in 60 patients.
The medical history, laboratory findings, gallbladder ultrasounds, timing of operation from the onset of symptoms, conversion rates to open procedures, operative times, intraoperative findings, complications, postoperative length of stay, cost of operative procedures and hospitalizations, and convalescence times were collected.
Laparoscopic cholecystectomy was attempted in 16 patients within 72 hours of the onset of symptoms of acute cholecystitis (group 1), in 19 patients with symptoms between 4 and 7 days (group 2), and in 25 patients with symptoms lasting more than 7 days (group 3). The only factor (eg, preoperative laboratory and ultrasound findings) that affected the outcome of the operation was duration of symptoms prior to operation. Patients who had LC done within 72 hours of the onset of symptoms had lower rates of conversion to open procedures, less difficult operations, shorter operative times, less costly procedures, and a shorter convalescence than those with symptoms for longer than 72 hours prior to operation. The conversion rates in patients operated within and after 72 hours were 12% and 30%, respectively. There were no bile duct injuries and no mortalities.
Laparoscopic cholecystectomy can be performed safely in most patients with acute cholelithiasis. However, we found that the duration of symptoms prior to LC affected the outcome; the conversion rates, hospital costs, and convalescence times increased in operated-on patients with symptoms for more than 72 hours. In our opinion, interval cholecystectomy may be a superior option in this latter group of patients.
回顾急性胆囊炎患者行腹腔镜胆囊切除术（LC）的结果，关注成本和临床结局。
回顾性研究。
大型私立都市教学医院。
1993年1月至1995年2月期间，我院有446例患者接受了LC手术。经临床、实验室、手术及组织病理学检查确诊为急性胆囊炎的患者有60例。
收集病史、实验室检查结果、胆囊超声检查、症状出现至手术的时间、转为开放手术的比例、手术时间、术中发现、并发症、术后住院时间、手术及住院费用以及康复时间。
对16例急性胆囊炎症状出现72小时内的患者（第1组）、19例症状出现4至7天的患者（第2组）和25例症状持续超过7天的患者（第3组）尝试进行腹腔镜胆囊切除术。影响手术结局的唯一因素（如术前实验室及超声检查结果）是手术前症状持续时间。症状出现72小时内行LC手术的患者，转为开放手术的比例较低，手术难度较小，手术时间较短，费用较低，康复时间也比症状出现超过72小时的患者短。72小时内及72小时后手术患者的转为开放手术比例分别为12%和30%。无胆管损伤及死亡病例。
大多数急性胆石症患者可安全地进行腹腔镜胆囊切除术。然而，我们发现LC术前症状持续时间会影响手术结局；症状超过72小时的手术患者，转为开放手术的比例、住院费用及康复时间均增加。我们认为，对于后一组患者，择期胆囊切除术可能是更好的选择。
