Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited
Emergent laparoscopic cholecystectomy for acute acalculous cholecystitis revisited
复制标题
急诊腹腔镜胆囊切除术治疗急性非结石性胆囊炎的再探讨
作者：
Ueno;D. Nakashima;H. Higashida;M. Yoshida;K. Hino;K. Irei;I. Moriya;T. Matsumoto;H. Hirai;T. Nakamura;M
目的比较急诊腹腔镜胆囊切除术治疗急性结石性胆囊炎（AAC）与手术治疗急性结石性胆囊炎（ACC）的安全性。方法回顾性分析2010年1月至2014年4月川崎医学院消化外科急诊腹腔镜胆囊切除术治疗急性胆囊炎111例患者的围手术期记录。将患者分为AAC组（27例）和ACC组（84例），比较两组患者围手术期预后。结果与ACC组相比，AAC组患者疾病严重程度和美国麻醉医师学会生理状态评分均显著增高（p= 0.001和0.037），血红蛋白和白蛋白浓度均显著降低（p= 0.0005和0.017），红细胞压积和血小板计数均显著降低（p< 0.0001和0.040）。当我们比较围手术期结果时，我们还发现AAC组的患者更有可能接受输血（p= 0.002），并需要转换为开放手术（p= 0.008）。发病率、死亡率和住院时间没有显著差异。结论早期腹腔镜胆囊切除术治疗急性结石性胆囊炎和急性结石性胆囊炎是安全的。
PurposeTo compare the safety of emergent laparoscopic cholecystectomy for acute acalculous cholecystitis (AAC) with surgery for acute calculous cholecystitis (ACC).MethodsWe retrospectively reviewed the perioperative records of 111 patients who underwent emergent laparoscopic cholecystectomy for acute cholecystitis under the care of the Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, between January 2010 and April 2014. Patients were divided into the AAC group (27 patients) and the ACC group (84 patients), and their perioperative outcomes were compared.ResultsPatients in the AAC group had significantly higher disease severity and American Society of Anesthesiologists physical status scores (p= 0.001 and 0.037, respectively), lower blood hemoglobin and albumin concentrations (p= 0.0005 and 0.017, respectively), and lower hematocrit and platelet count (p< 0.0001 and 0.040, respectively) than those in the ACC group. When we compared perioperative outcomes, we also found that patients in the AAC group were more likely to have received a blood transfusion (p= 0.002) and to have required conversion to open surgery (p= 0.008). There were no significant differences in morbidity, mortality or length of hospital stay.ConclusionsEarly laparoscopic cholecystectomy is safe in acute acalculous as well as acute calculous cholecystitis.