Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study
Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study
复制标题
DOI：
10.1002/jhbp.456
复制
发表时间：
2017-06-01
影响因子：
3
通讯作者：
Yamamoto, Masakazu
中科院分区：
文献类型：
--
作者：
Endo, Itaru;Takada, Tadahiro;Yamamoto, Masakazu
背景尽管急性胆囊炎的早期腹腔镜胆囊切除术已被广泛采用，但临床上对急性胆囊炎患者行胆囊切除术的最佳时机仍存在争议。本研究旨在确定急性胆囊炎患者的最佳治疗方法，重点关注疾病的严重程度和合并症。方法进行了一项为期2年的国际多中心回顾性观察研究。患者分为四组：A组：原发性胆囊切除术;组B：胆囊引流后胆囊切除术;组C：单纯胆囊引流;组D：单纯药物治疗。Charlson合并症指数（CCI）评分< 6分与> 6分患者的死亡率差异有统计学意义（P < 0.001）。A组患者入院后0- 3d手术时间最短（P < 0.01）。多元回归分析显示CCI和低体重指数
BackgroundAlthough early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities.MethodsAn international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone.ResultsThe subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index