急性结石性胆囊炎早期行腹腔镜手术的可行性

Feasibility analysis of early laparoscopic surgery for acute calculous cholecystitis

目的:探讨《东京指南2018》指导下多中心急性结石性胆囊炎早期腹腔镜手术的可行性。方法:回顾分析2000年1月至2019年12月收治的行腹腔镜胆囊切除术的3147例急性结石性胆囊炎患者的临床资料,根据发病至手术的时间分为早期腹腔镜胆囊切除术(ELC)组(发病至手术时间≤7 d,n=3085)与延迟腹腔镜胆囊切除术(DLC)组(发病至手术时间>7 d,n=62),再将ELC组分为早期ELC组(发病至手术时间≤3 d,n=1503)与延迟ELC组(发病至手术时间4~7 d,n=1582)两个亚组。对比分析患者术前一般情况、术中处理情况、术后并发症及住院时间;结果:ELC组中转开腹率低于DLC组,术后住院时间、住院总时间短于DLC组,差异有统计学意义(P<0.05),ELC组与DLC组术后并发症发生率差异无统计学意义。亚组分析显示早期ELC组术后住院时间、总住院时间短于延迟ELC组,两组并发症发生率差异无统计学意义。结论:通过对多个医疗中心患者的临床资料进行综合分析证明,急性结石性胆囊炎在《东京指南2018》指导下行ELC是安全、可行的,该指南对肝胆外科临床具有明显的实用性与指导作用,值得推广应用。

Objective:To investigate the feasibility of early laparoscopic cholecystectomy(ELC)for acute calculous cholecystitis under the guidance of Tokyo guideline 2018.Methods:From Jan.2000 to Dec.2019,clinical data of 3147 acute calculous cholecystitis patients who were treated with laparoscopic cholecystectomy were retrospectively analyzed.All patients were divided into ELC group(the time from onset to operation≤7 d,n=3085)and delayed laparoscopic cholecystectomy(DLC)group(the time from onset to operation>7 d,n=62)according to the time from onset to operation.Then the patients in the ELC group were divided into two groups:the early ELC group(the time from onset to operation≤3 d,n=1503)and the delayed ELC group(the time from onset to operation 4-7 d,n=1582).The preoperative general situation,intraoperative treatment,postoperative complications and hospital stay were compared.Results:The rate of conversion to laparotomy in the ELC group was significantly lower than that in the DLC group,the postoperative hospital stay and total hospital stay were significantly shorter than those in the DLC group,the differences were statistically significant(P<0.05);the incidence of postoperative complications between the ELC group and the DLC group was not significantly different.The subgroup analysis showed that the postoperative hospital stay and total hospital stay of early ELC group were shorter than those of delayed ELC group,but there was no significant difference in the incidence of complications.Conclusions:Through the comprehensive analysis of patients'clinical data in multiple medical centers,it is proved that under the guidance of Tokyo guideline 2018,ELC for acute calculous cholecystitis is safe and feasible.Tokyo guideline 2018 has obvious practical and guiding effect in hepatobiliary surgery,and is worthy of clinical popularization and application.