Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.
Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials.
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DOI：
10.1186/s13017-021-00360-5
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发表时间：
2021-03-25
期刊：
影响因子：
--
通讯作者：
Kluger Y
中科院分区：
文献类型：
--
作者：
Borzellino G;Khuri S;Pisano M;Mansour S;Allievi N;Ansaloni L;Kluger Y
急性胆囊炎的早期胆囊切除术已被证明可以缩短住院时间，但与延迟手术相比，对发病率没有好处。然而，在文献中，早期时机是指在入院后96小时或症状发作后1周内进行胆囊切除术。考虑到急性胆囊炎的自然病史，基于这样一系列早期时机的分析可能错过了一个潜在的优势，可以假设胆囊切除术的早期时机仅限于疾病的初始阶段。本综述旨在探讨与延迟胆囊切除术相比，采用入院后24 h内立即胆囊切除术作为早期时机可减少术后并发症的假设。根据患者干预结局比较研究（PICOS）策略进行文献检索。纳入了比较急性胆囊炎早期和延迟胆囊切除术后并发症发生率的随机试验。根据胆囊切除术的时间对研究进行分组。在亚组分析中，通过比较入院24小时内进行胆囊切除术的早期时间和入院24小时内进行胆囊切除术的早期时间与入院24小时内进行胆囊切除术的延迟时间，探讨了入院24小时内立即进行胆囊切除术可以减少术后并发症的假设。文献结果允许进行第二次分析，其中胆囊切除术的早期时机不是指入院，而是指症状的发作。入院后24小时内立即行胆囊切除术并不能减少术后并发症，相对危险度（RR）为1.89，95%可信区间（CI）为[0.76; 4.71]。当时机基于症状出现时，发现与延迟胆囊切除术相比，在症状出现72小时内进行胆囊切除术可显着减少术后并发症，RR = 0.60 [95%CI 0.39;0.92]。目前的研究未能证实以下假设，即在入院后24小时内立即进行胆囊切除术可以减少术后并发症，除非在症状发作后72小时内进行手术。
Early cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy. The literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms. Immediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92]. The present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.