Lai P B, Kwong K H, Leung K L, Kwok S P, Chan A C, Chung S C, Lau W Y
Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories.
Br J Surg. 1998 Jun;85(6):764-7. doi: 10.1046/j.1365-2168.1998.00708.x.
The aim of this prospective randomized study was to define the optimum management between early and delayed laparoscopic cholecystectomy for patients with acute cholecystitis.
Patients were randomized to receive either early laparoscopic cholecystectomy within 24 h of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6-8 weeks later.
There were 53 patients in the early group and 51 in the delayed group. There was no significant difference in conversion rate (early 21 per cent versus delayed 24 per cent), postoperative analgesic requirement (1 versus 2 doses) and postoperative complications. However, the early group had significantly longer operating time (122.8 versus 106.6 min, P = 0.04) and shorter total hospital stay (7.6 versus 11.6 days, P < 0.001).
Early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay. Apart from a shorter operating time, treating patients with delayed laparoscopic cholecystectomy does not offer additional benefit.
这项前瞻性随机研究的目的是确定急性胆囊炎患者早期与延迟腹腔镜胆囊切除术的最佳治疗方案。
患者被随机分为两组，一组在随机分组后24小时内接受早期腹腔镜胆囊切除术，另一组先接受初始保守治疗，6 - 8周后再接受延迟腹腔镜胆囊切除术。
早期组有53例患者，延迟组有51例患者。两组在中转率（早期21%对延迟24%）、术后镇痛需求（1剂对2剂）和术后并发症方面无显著差异。然而，早期组的手术时间明显更长（122.8分钟对106.6分钟，P = 0.04），总住院时间更短（7.6天对11.6天，P < 0.001）。
早期腹腔镜胆囊切除术对于急性胆囊炎是安全可行的，且具有缩短总住院时间的额外益处。除了手术时间较短外，延迟腹腔镜胆囊切除术治疗患者并无额外益处。
