Early Laparoscopic Cholecystectomy for Acute Cholecystitis: a New Standard of Definite Treatment

急性膽囊炎的早期腹腔鏡膽囊摘除手術：治療方法的新準則

劉曉東(Hsaio-Dung Liu) ； 劉耀基(Yao-Chi Liu) ； 陳穎信(Ying-Hsin Chen) ； 陳之凱(Victor T. K. Chen) ； 沈國樑(Kuo-Liang Shen) ； 趙有誠

《Journal of Medical Sciences》 20卷2期 (1999/10) Pp. 60-68

摘要

適當腹腔鏡膽囊摘除術的時機，在急性膽囊炎的治療上仍有爭議。到底是早期抑或階段性的腹腔鏡手術（interval elective laparoscopic surgery）對急性膽囊炎可獲致最好的本益比？此一前瞻性隨機研究，希望能得到對上述問題清楚的解答。在29個月的研究過程中，共有97位病患以急性膽囊炎的臨床診斷被隨機分配為早期腹腔鏡膽囊摘除術組（入院72小時內，n=48）；或在內科保守治療後，進入階段性延遲腹腔鏡膽囊摘除術組（n=49）。我們的結論急性膽囊炎若以初始保守治療後，繼以階段性腹腔鏡手術，並不能減少罹病率及轉回傳統手術率。而早期在72小時內施以腹腔鏡或傳統剖腹膽囊摘除術，應為更安全且其有實際的社會經濟功能的益處。

關鍵字

急性膽囊炎 ； 早期腹腔鏡膽囊摘除手術

並列摘要

High complications and conversion rate associated with laparoscopic treatment for acute cholecystitis was a common sense by surgeons. The optimal time of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Either early or interval elective to undergo laparoscopic cholecystectomy for acute cholecystitis could gain the best cost/beneficial ratio. A prospective randomized study was performed to make it clear. During a 29-month period, 97 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n= 48) or delayed interval surgery after initial medical treatment (delayed group, n=49). Thirteen patients (five in the early group and eight in the delayed group) were excluded because of refusal of operation (n=5), misdiagnosis (n=5), contraindication for laparoscopic surgery (ca. of gallbladder), or loss of follow-up (n=2). Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n=3) and persistent fever (n=5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs.11%; p=0.174) and complication rate (29% vs.13%; p=0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p=0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p＜0.001) and recuperation period (19 days vs.12 days; p＜0.001).We concluded that initial conservative treatment followed by interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early laparoscopic or traditional cholecystectomy within 72 hours may be safer and has definite socioeconomic benefits.

並列關鍵字

acute cholecystitis ； early laparoscopic cholecystectomy