Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study

被引：79

作者：

Endo, Itaru ^{[1
]}

Takada, Tadahiro ^{[2
]}

Hwang, Tsann-Long ^{[3
]}

Akazawa, Kohei ^{[4
]}

Mori, Rintaro ^{[5
]}

Miura, Fumihiko ^{[2
]}

Yokoe, Masamichi ^{[6
]}

Itoi, Takao ^{[7
]}

Gomi, Harumi ^{[8
]}

Chen, Miin-Fu ^{[3
]}

Jan, Yi-Yin ^{[3
]}

Ker, Chen-Guo ^{[9
]}

Wang, Hsiu-Po ^{[10
]}

Kiriyama, Seiki ^{[11
]}

Wada, Keita ^{[2
]}

Yamaue, Hiroki ^{[12
]}

Miyazaki, Masaru ^{[13
]}

Yamamoto, Masakazu ^{[14
]}

机构：

[1] Yokohama City Univ, Dept Surg Gastroenterol, Grad Sch Med, Yokohama, Kanagawa, Japan

[2] Teikyo Univ, Dept Surg, Sch Med, Tokyo, Japan

[3] Lin Kou Chang Gung Mem Hosp, Div Gen Surg, Tayuan, Taiwan

[4] Niigata Univ, Dept Med Informat, Niigata, Japan

[5] Natl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan

[6] Japanese Red Cross Nagoya Daini Hosp, Dept Gen Internal Med, Nagoya, Aichi, Japan

[7] Tokyo Med Univ Hosp, Dept Gastroenterol & Hepatol, Tokyo, Japan

[8] Univ Tsukuba, Ctr Global Hlth, Mito Kyodo Gen Hosp, Ibaraki, Japan

[9] Yuans Gen Hosp, Dept Surg, Kaohsiung, Taiwan

[10] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Dept Internal Med, Coll Med, Taipei, Taiwan

[11] Ogaki Municipal Hosp, Dept Gastroenterol, Gifu, Japan

[12] Wakayama Med Univ, Dept Surg 2, Sch Med, Wakayama, Japan

[13] Chiba Univ, Grad Sch Med, Chiba, Japan

[14] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan

来源：

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES | 2017年 / 24卷 / 06期

关键词：

Acute cholecystitis; Cholecystostomy; Comorbidity; Laparoscopic cholecystectomy; DELAYED LAPAROSCOPIC CHOLECYSTECTOMY; TRANSHEPATIC GALLBLADDER DRAINAGE; PERCUTANEOUS CHOLECYSTOSTOMY; SURGICAL-MANAGEMENT; OPTIMAL-TIME; ILL PATIENTS; P-POSSUM; METAANALYSIS; RISK; MORBIDITY;

D O I：

10.1002/jhbp.456

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BackgroundAlthough early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. MethodsAn international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. ResultsThe subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. ConclusionEven patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.

引用

页码：346 / 361

页数：16

共 43 条

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