经皮肝穿刺胆囊引流联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术对中度急性胆囊炎疗效的Meta分析

目的 系统评价经皮肝穿刺胆囊引流联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术的治疗方案选择对中度急性胆囊炎的治疗效果及不良反应。方法 检索PubMed、EMBASE、Web of Science、Cochrane Library、中国期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBM）、万方数据库中有关经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术对中度急性胆囊炎治疗的随机对照试验研究，检索时限为建库之日起至2018 年5 月。所有检索出并纳入研究的文献均由2 名研究者进行独立的文献质量评价和数据提取。文献数据统一采用RevMan 5.3 软件进行分析，对无法进行Meta分析的文献指标进行描述性分析。结果 总共纳入11 篇文献，包括1 283 例中度急性胆囊炎患者。Meta分析结果显示：在发生中度急性胆囊炎时经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术与急诊腹腔镜胆囊切除术相比可降低中转开腹率（RR 0.45，95%CI 0.23～0.85，P=0.01），减少术中出血量（SMD -41.50，95%CI -51.18～-31.82，P＜0.001）和术后并发症发生率（RR 0.50，95%CI0.31～0.81，P＜0.001），但两种治疗方式在手术时间上的差异并无统计学意义（SMD 1.10，95%CI -4.27～6.47，P=0.69）。此外，经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术比急诊腹腔镜胆囊切除术能够更好地缩短患者术后住院时间（SMD -1.21，95%CI -2.17～-0.25，P=0.01）。结论 在治疗中度急性胆囊炎时，经皮肝穿刺胆囊引流术联合腹腔镜胆囊切除术比急诊腹腔镜胆囊切除术具有更好的效果。     

What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema?

Purpose

With the accumulating experience in laparoscopic surgery, early laparoscopic cholecystectomy (LC) is increasingly offered for acute cholecystitis. However, early LC without percutaneous transhepatic gallbladder drainage (PTGBD) for gallbladder empyema is still believed to be unsafe. The purpose of this study was to determine the optimal time for LC in gallbladder empyema.

Methods

A retrospective analysis was carried out of patients who underwent LC without PTGBD for gallbladder empyema between August 2007 and December 2010. All cases were confirmed by biopsy. The patients were divided into two groups on the basis of a cutoff of 72 h.

Results

LC for gallbladder empyema was performed without PTGBD in 61 patients during the study period. The overall conversion rate was 6.6 %. Based on the 72 h cutoff, there were 33 patients in the early group and 28 in the delayed group. There were no significant differences between early and late patients with respect to operation duration (75.5 vs. 71.4 min, p = 0.537), postoperative hospital stay (4.2 vs. 3.3 days, p = 0.109), conversion rate (12.1 vs. 0 %, p = 0.118), and complication rate (12.1 vs. 3.6 %, p = 0.363). However, the early group had a significantly shorter total hospital stay (5.3 vs. 8.7 days, p = 0.001).

Conclusions

Early LC without PTGBD is safe and feasible for gallbladder empyema and is associated with a low conversion rate. Delayed LC for gallbladder empyema has no advantages and results in longer total hospital stays. LC should be performed as soon as possible within 72 h after admission to decrease length of hospital stay.     

急性重症胆囊炎手术时机选择分析

目的:探讨急性重症胆囊炎手术时机的选择。方法:回顾性分析156例急性重症胆囊炎(ASC)行腹腔镜下胆囊切除术(LC)或行经皮经肝胆囊穿刺引流术(PTGBD)后择期LC患者的临床资料。其中21例行急诊LC,89例于PTGBD后2个月内行LC,46例于PTGBD后2个月以上行LC。比较不同手术时机患者的相关临床指标。结果:与PTGBD后择期LC患者比较,急诊LC患者的中转开腹例数、住院总费用差异无统计学意义(均P0.05),但在术中出血量、手术时间、术后住院时间、术后抗生素使用天数、术后疼痛需用镇痛药者、术后并发症发生率均明显增加(均P0.05)。PTGBD后不同择期LC患者比较,以上指标差异均无统计学意义(均P0.05)。结论:对于ASC,不宜早期行急诊LC术,而行PTGBD后2个月内或2个月以上的择期LC术更为合理。     

Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis

Many surgeons have found it difficult to decide whether to apply percutaneous transhepatic gallbladder drainage (PTGBD) in patients with acute cholecystitis that is not responsive to initial medical management (IMMx), because the indications of PTGBD are ambiguous. The aim of this study was to evaluate the appropriate treatment for acute cholecystitis that is not responsive to IMMx. Specifically, we focused on differences in surgical outcomes between elective and emergency laparoscopic surgeries. Between March 2006 and February 2009, 738 patients with acute cholecystitis who had undergone laparoscopic cholecystectomy (LC) at our institution were retrospectively studied. We divided them into 3 groups. Group I included 494 patients who underwent elective LC without pre-operative PTGBD, group II included 97 patients who intended to undergo elective LC after preoperative PTGBD, and group III included 147 patients who underwent emergency LC without preoperative PTGBD. We compared age, sex, symptom duration, body temperature, leukocyte counts, and American Society of Anesthesiologists (ASA) class on admission as clinical characteristics. We compared the time interval from symptom development and admission to surgery, operative time, the conversion rate to open surgery, postoperative complications, the total length of stay, and the postoperative length of stay as perioperative surgical outcomes. For patients with ASA 2 and 3, the conversion rate to open surgery in group II was significantly less than that in group III (P<.05, P<.01, respectively). We recommend PTGBD as the first choice for acute cholecystitis in patients who show no improvement after IMMx, to allow the patient to undergo an elective LC rather than emergency surgery for patients with ASA 2 and 3.     

彩超引导下经皮经肝胆囊穿刺置管引流治疗41例高危人群急性胆囊炎

目的评价彩超引导下经皮经肝胆囊穿刺引流(PTGBD)治疗高危人群急性胆囊炎的价值。方法回顾性分析从2014年3月至2017年4月江门市中心医院肝胆外科41例高危人群急性胆囊炎临床资料。结果所有患者均顺利完成PTGBD,术后2例出现胆道出血,经保守治疗后治愈,无胆漏、穿孔等并发症发生,无死亡病例。3例患者院外出现导管脱落,因症状好转,患者不同意手术而未进一步治疗;3例因心肺功能无法耐受手术、6例因患者不同意手术拔除引流管。以上病例随访6~24月未见胆囊炎急性发作。29例顺利接受LC术,无中转开腹病例。PTGBD后2周~3月施行LC,平均手术时间74.9±67.3 min,术中出血约7.2±9.2 m L,术后住院时间2.6±2.1天,术后有1例出现腹腔出血,经保守治疗后治愈出院,无胆道出血、胆道损伤、胆漏等术后并发症发生。胆囊壁厚度与LC时间呈正相关,相关系数为0.455(P=0.013)。结论彩超引导下PTGBD可有效控制胆囊急性炎症,为后续施行腹腔镜下胆囊切除术创造条件。     

Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis.     

老年急性胆囊炎患者PTGBD后LC手术实施时机及其影响因素

目的 探讨老年急性胆囊炎患者经皮经肝胆囊穿刺引流（PTGBD）后安全的LC手术时机和影响因素。方法 选取2020年6月至2022年7月间在新疆维吾尔自治区第三人民医院接受PTGBD+择期LC手术治疗的老年急性胆囊炎患者120例进行前瞻性研究,按照PTGBD后不同时期实施LC手术,将患者随机分为4组：4周组（n=30）、6周组（n=30）、8周组（n=30）和10周组（n=30）。对术前资料、术中困难程度评分、手术相关指标、手术损伤和手术并发症进行组间对比,并分析手术时机的影响因素。结果 4组术前资料的比较,差异无统计学意义（P>0.05）;针对胆囊周围表现、胆囊三角表现、胆囊床表现等单项困难程度评分和术中困难程度总评分,4周组均显著高于6周组、8周组和10周组;针对术中胆囊及其周围其他表现评分,4周组高于8周组和10周组;差异均具有统计学意义（P<0.05）;针对手术时间、术中出血量和腹腔引流量,4周组均显著高于6周组、8周组和10周组;差异均具有统计学意义（P<0.05）。4组胆囊部分切除率、术后排气时间和术后住院时间的比较,差异无统计学意义（P>0.05）;...     

超声引导下胆囊穿刺引流术治疗老年急性高危胆囊炎

目的 探讨超声引导下胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage,PTGBD）治疗老年急性高危胆囊炎的疗效。方法 回顾性分析2016年1月至2020年1月浙江省台州市立医院肝胆外科收住的67例老年急性高危胆囊炎行PTGBD的临床资料,比较PTGBD术前术后的疼痛评分、体温、白细胞计数、CRP水平、肝功能、CA199水平,分析PTGBD术后并发症、胆汁培养及进一步治疗情况。结果67例老年急性高危胆囊炎患者均顺利完成PTGBD术。与术前比较,PTGBD术后患者疼痛评分、体温、白细胞计数、CRP、总胆红素、谷丙转氨酶、谷草转氨酶、CA199水平均明显下降（P＜0.01）。PTGBD术后出现并发症7例,其中出血4例,拔管后出现胆瘘3例。胆汁细菌培养阳性33例,其中大肠杆菌19例,肺炎克雷伯菌9例,粪肠球菌3例,铜绿假单胞菌2例。PTGBD术后进一步治疗情况：67例中27例于PTGBD术后1周内行腹腔镜胆囊切除术（LC）,19例于PTGBD术后1～3个月行LC手术,16例因症状缓解拒绝行进一步手术治疗,5例失访。结论对于老年急性高危胆囊炎患者行PTGBD安全有效,不适合急诊手术的患者近期可获得有效缓解。     

经皮肝胆囊穿刺置管引流术治疗创伤后中重度急性非结石性胆囊炎

目的 探讨经皮肝胆囊穿刺置管引流术(percutaneous transhepatic gallbladder drainage,PTGD)治疗创伤后中重度急性非结石性胆囊炎的临床疗效.方法 对2017年1月至2020年8月华北医疗健康集团邢台总医院普通外科收治的29例创伤(包括创伤和手术)后急性非结石性胆囊炎患者的临...     

经皮经肝胆囊穿刺引流术和延期的腹腔镜胆囊切除术治疗老年急性胆囊炎

目的 评价经皮经肝胆囊穿刺引流术（percutaneous transhepatic gallbladder drainage,PTGBD）和延期腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗老年急性胆囊炎的价值。方法 回顾分析2001年1月～2005年12月30例老年（〉65岁）急性胆囊炎使用PTGBD的临床资料。均为伴有严重内科疾病和（或）保守治疗症状不缓解的患者。结果 29例导管置入成功,1例因胆囊内充满结石置管未成功,行胆汁抽吸术。并发症包括导管脱落2例（1例重新插入,1例症状缓解未再插入）,1例因病情加重,后改行胆囊造瘘＋腹腔冲洗引流术。27例带管出院。25例PTGBD后3周拔管,2例胆囊管梗阻中1例引流管脱落,1例保留至8周后手术。28例结石性胆囊炎接受延期手术：25例LC,2例经窦道行胆道镜胆囊取石,1例伴有胆总管结石因发现有腹膜后肿物（肾上腺肿物）行开腹手术。另4例胆总管结石中,2例在LC同时行胆道镜取石,2例LC后行内镜下十二指肠乳头切开取石术。无死亡,无胆道损伤等严重并发症。结论 对于急性胆囊炎的老年病人,结合使用PTGBD和延期的LC是安全和有效的。     

预康复干预在老年急性胆囊炎序贯性外科治疗中作用研究

目的 评估预康复干预在老年急性胆囊炎病人行急诊经皮经肝胆囊穿刺置管引流（PTGBD）和二期腹腔镜胆囊切除术（LC）间期的应用价值。方法 收集2019年12月至2021年4月北京医院连续收治的年龄＞65岁的胆囊结石合并急性胆囊炎一期行急诊PTGBD，门诊行预康复干预，二期行LC病人资料，作为预康复组；选取同时期年龄＞65岁、连续入院的胆囊结石合并慢性胆囊炎行择期LC病人作为对照组。比较预康复组和对照组行LC时血实验室检查指标、手术时间、中转开放手术率、严重手术并发症发生率、术后住院日及住院总费用。结果 预康复组共纳入30例病人，对照组纳入33例病人。预康复组相对于对照组，手术时间延长（80 min vs. 60 min，P＜0.01）、放置腹腔引流率高（50.00% vs. 9.09%，P=0.001）、住院总费用增加（21 507.29元 vs. 13 693.07元，P＜0.01）。但两组中转开放手术率（3.33% vs. 0，P=0.223）、手术并发症发生率（6.67% vs. 0，P=0.476）差异并无统计学意义。结论 预康复干预可改善老年急性胆囊炎急诊PTGBD术后至二期LC期间的身体状态，使手术并发症和中转开腹的发生率接近择期LC。     

CT引导下经皮经肝胆囊穿刺置管引流联合择期腹腔镜胆囊切除术治疗高龄急性重症胆囊炎效果分析

目的分析CT引导下经皮经肝胆囊穿刺置管引流(PTGBD)联合择期腹腔镜胆囊切除术(LC)治疗高龄急性重症胆囊炎(SAC)的效果。方法选取2018-01-2019-12间收治的112例高龄SAC患者,对照组行急诊LC,观察组行CT引导下PTGBD联合择期LC,每组56例。比较2组的疗效。结果观察组手术时间、术中出血量,以及术后肛门排气时间、并发症发生率和住院时间均少(短)于对照组,差异均有统计学意义(P<0.05)。结论CT引导下PTGBD联合择期LC术治疗高龄SAC,安全、有效,有利于患者术后康复。     

PTGBD序贯择期LC治疗急性胆囊炎的最佳时机探讨

目的 探讨经皮经肝胆囊穿刺引流（PTGBD）序贯择期腹腔镜胆囊切除术（LC）治疗急性胆囊炎的最佳时机。方法 回顾性分析2016年1月至2022年2月达州市中心医院肝胆外科收治的114例急性胆囊炎患者临床资料，根据择期LC手术难度，将患者分为非困难组（n=62）和困难组（n=52），比较两组相关临床及生化指标情况。通过PTGBD-LC间隔时间预测手术难度绘制ROC曲线，得出截断值。以该值为节点分为短间隔组（n=58）和长间隔组（n=56）两组，比较两组患者围手术期指标情况。以PTGBD-LC间隔时间为自变量、困难LC比例为因变量，进一步绘制拟合曲线，研究PTGBD-LC间隔时间与LC难度之间的关系。结果 本研究共纳入114例患者，非困难组患者的查尔森合并症指数、上腹部手术史比例、生化指标（NLR、PLR、ALT和γ-GT）及手术时间明显低于困难组（均P<0.05），而PTGBD-LC间隔时间明显长于困难组（P<0.05）。以PTGBD-LC间隔时间预测手术难度绘制ROC曲线，得出AUC为0.778，截断值为53.5 d，当PTGBD-LC间隔时间>53.5 d时，困难L...     

Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis

Aim: The present study was conducted to evaluate the effectiveness of early scheduled laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis. Patients and methods: 31 patients with acute cholecystitis were treated by early scheduled LC following PTGBD (group 1). These patients were compared with 9 patients treated by early LC without PTGBD (group 2) and with 12 patients treated by delayed LC following conservative therapy (group 3) for the success rate of intraoperative cholangiography, the conversion rate to open cholecystectomy, operative time, and hospital stay. Early scheduled LC following PTGBD was defined as scheduled LC when the patient's condition recovered and it was performed 1–7 days (mean: 4 days) after admission. The patients' age in group 1, 2, and 3 was 66 ± 13, 65 ± 10, and 64 ± 9 years, respectively, without significant difference. Most of the patients had additional diseases. Results: The success rate of intraoperative cholangiography was 97% (30/31) in group 1, 67% (6/9) in group 2, and 67% (8/12) in group 3. The conversion rate to open cholecystectomy was 3% (1/31) in group 1, 33% (3/9) in group 2, and 33% (4/12) in group 3. The operative time for LC was 89 ± 33 min in group 1, 116 ± 24 min in group 2, and 135 ± 30 min in group 3. The mean hospital stay after LC was 9 ± 4 days in group 1, 9 ± 3 days in group 2, and 17 ± 7 days in group 3. In group 1, the success rate of intraoperative cholangiography was higher, the conversion rate to open cholecystectomy was lower, and operative time was shorter than in groups 2 and 3 with significant difference (p <0.05, p <0.05, and p <0.01, respectively). Conclusion: The findings of this study indicate that early scheduled LC following PTGBD is a safe and effective therapeutic option for patients with acute cholecystitis especially in elderly and complicated patients.     

A survey of the timing and approach to the surgical management of patients with acute cholecystitis in Japanese hospitals

Background/Purpose Despite the fact that there is evidence advocating early laparoscopic cholecystectomy for acute cholecystitis (AC), the practice of this treatment has not been investigated sufficiently. This study was designed to assess the current practice of laparoscopic cholecystectomy for AC among Japanese general surgeons. Methods A postal questionnaire was sent to the 291 councillors of the Japanese Society of Abdominal Emergency Medicine in order to ascertain their current management of patients with AC. Results The response rate was 72.5%. A policy of early cholecystectomy for AC was adopted by 41.7% of the responding surgeons. However, almost the same percentage of surgeons routinely managed their patients conservatively, and opted for delayed cholecystectomy at a later date. The adoption of laparoscopic cholecystectomy was made by 79.1% of surgeons. Laparoscopic cholecystectomy for patients with AC who had percutaneous transhepatic gallbladder drainage (PTGBD) was adopted by 73.9% of the surgeons. Of the surgeons opting for laparoscopic cholecystectomy, 37.3% performed intraoperative cholangiography laparoscopically for all patients with AC. Conclusions Although early cholecystectomy for patients with AC was not adopted by the majority of the surgeons who responded, laparoscopic cholecystectomy was a common procedure for early and delayed cholecystectomy. Despite evidence that strongly supports the use of early cholecystectomy, the use of this treatment remains suboptimal in Japan.     

Surgical Outcomes of Laparoscopic Cholecystectomy for Severe Acute Cholecystitis

The aim of this study was to evaluate the surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with severe acute cholecystitis (SAC) and to clarify the useful treatment modalities of SAC. Of 112 patients who presented SAC, we selected 99 patients and divided them into 3 groups: 37 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD; group 1), 62 patients with SAC but not indicated for PTGBD (group 2), and 59 patients with acute and chronic cholecystitis (group 3). The conversion rate was 2.7% (1/37) in group 1, 6.5% (4/62) in group 2, and 1.7% (1/59) in group 3. In groups 1 and 2, the postoperative stay and operative time were longer than those in group 3 with significant difference, respectively (P < 0.05). In group 2, there was correlation not only between postoperative stay and age but also between postoperative stay and ASA class (P < 0.05). In group 2, there was no correlation between time to operation and operative time and also between time to operation and postoperative stay, however, there was surprisingly significant correlation between time to operation and conversion rate in SAC (P = 0.018). In conclusion, PTGBD should selectively be performed in patients with severe comorbidities rather than improving surgical outcomes of LC for severe acute cholecystitis. If patients are not indicated for PTGBD, an early laparoscopic cholecystectomy is recommended because it can decrease conversion rate, although it cannot decrease operative time and postoperative stay.     

经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗老年急性梗阻性胆囊炎的体会

目的:探讨B超引导下经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)联合二期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗老年急性梗阻性胆囊炎的疗效。方法:回顾分析2008年1月至2011年2月为78例老年急性结石性胆囊炎患者行PTGD联合二期LC的临床资料。结果:78例均穿刺置管成功,术后2～3 h腹痛减轻,体温24～48 h降至正常,PTGD管平均留置13.5天,分别于6～48天后行LC。3例中转开腹,无一例因急性梗阻性胆囊炎及相关治疗导致的严重并发症或死亡。结论:PTGD联合二期LC是治疗老年急性梗阻性胆囊炎安全、简便、有效的方法。老年急性梗阻性胆囊炎应尽量避免急诊常规手术,宜先行PTGD,缓解炎症,以免发生胆囊穿孔,待二期择期行LC。     

Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis

BACKGROUND: Many studies have concluded that delayed or interval laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) demonstrated higher conversion rates and complication rates compared with early LC. However, if the acutely inflamed gallbladder is decompressed by emergent percutaneous gallbladder drainage (PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC when the patient is in better condition. The purpose of this retrospective study was to assess the outcomes of delayed LC following PGBD in patients with AC. METHODS: A total of 72 LC for AC were divided into PGBD (n = 27) and non-PGBD groups (n = 45). The PGBD group had delayed LC (after 72 hours of admission). Thirty-two non-PGBD patients had early LC (within 72 hours of admission) and 13 non-PGBD had delayed LC. Outcome of delayed LC for the PGBD group was assessed by LC time, conversion rate, morbidity rate, and hospital stay, and compared with that of the non-PGBD group. RESULTS: Compared with early and delayed LC of the non-PGBD group, the PGBD group showed longer LC time (median 110 minutes versus 87.5 minutes versus 85 minutes, P <0. 05), a little lower conversion rate (15% versus 25% versus 23%), similar morbidity rate (15% versus 9% versus 15%), and prolonged hospital stay (13 days versus 7 days versus 10 days). CONCLUSIONS: PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with no PGBD. Thus, we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk groups such as elderly or critically ill patients and to acalculous cholecystitis.     

PTGBD联合LC对高龄急性胆囊炎合并糖尿病的疗效分析

目的 探讨经皮经肝胆囊穿刺引流(PTGBD)联合腹腔镜胆囊切除术(LC)对高龄急性胆囊炎合并糖尿病患者的疗效。方法 本回顾性研究以44例高龄急性胆囊炎合并糖尿病患者为研究对象,根据LC术前接受的治疗情况不同分为研究组(PTGBD组,n=20)和对照组(保守治疗组,n=24)。比较两组患者术中、术后各项指标的变化情况和并发症发生率。结果 研究组平均手术时间[(52.78±6.65)min vs(72.56±10.63)min]、术中出血量[(12.10±2.77)mL vs (18.52±2.47)mL]和术后住院时间[(5.85±0.75)d vs (8.91±1.09)d]均少于对照组(P<0.05),研究组首次排气时间[(20.33±2.99)h vs (28.27±4.38)h]及早期下床活动时间[(28.66±3.29)h vs (39.31±4.33)h]均早于对照组(P<0.05)。两组患者术后1 d的WBC、CRP、VAS评分差异没有统计学意义,但术后3 d两组WBC[(5.84±1.01)×10⁹/L vs (6.72±0.67)×10...     

Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases

Background

Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD?+?elective LC.

Material and methods

From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBD followed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups.

Results

A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5?years) compared with group 1 and group 3 (p?=?0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3.

Conclusions

Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD?+?LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD?+?LC can be preserved for those who carried a high risk of operation.