Lo C M, Liu C L, Fan S T, Lai E C, Wong J
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, China.
Ann Surg. 1998 Apr;227(4):461-7. doi: 10.1097/00000658-199804000-00001.
A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis.
Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates. It is not known whether there is a role for initial conservative treatment followed by interval elective operation.
During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1).
Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p = 0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p < 0.001) and recuperation period (19 days vs. 12 days; p < 0.001).
Initial conservative treatment followed by delayed interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.
开展一项前瞻性随机研究，比较急性胆囊炎早期与延迟腹腔镜胆囊切除术的效果。
急性胆囊炎的腹腔镜胆囊切除术与高并发症和中转开腹率相关。初始保守治疗后行择期手术是否有益尚不清楚。
在26个月期间，99例临床诊断为急性胆囊炎的患者被随机分为入院72小时内行早期腹腔镜胆囊切除术（早期组，n = 49）或初始内科治疗后行延迟手术（延迟组，n = 50）。13例患者（早期组4例，延迟组9例）因拒绝手术（n = 6）、误诊（n = 5）、手术禁忌（n = 1）或失访（n = 1）被排除。
延迟组41例患者中有8例因弥漫性腹膜炎（n = 3）和持续发热（n = 5）在入院后中位时间63小时（范围32至140小时）行急诊手术。尽管延迟组手术技术调整频率较低且手术时间较短，但中转率（23%对11%；p = 0.174）和并发症率（29%对13%；p = 0.07）有升高趋势。对于入院前症状超过72小时的38例患者，延迟手术后中转率仍较高（30%对17%；p = 0.454）。此外，延迟腹腔镜胆囊切除术延长了总住院时间（11天对6天；p < 0.001）和康复期（19天对12天；p < 0.001）。
初始保守治疗后行延迟手术不能降低急性胆囊炎腹腔镜胆囊切除术的发病率和中转率。入院72小时内行早期手术具有医学和社会经济益处，是有足够腹腔镜胆囊切除术经验的外科医生治疗患者的首选方法。
