早期或延迟的腹腔镜胆囊切除术用于胆囊穿孔.
Renqing Wu1, Ryan P Dumas, Vanessa Nomellini
1From the Division of Burn, Trauma, Acute, and Critical Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
The journal of trauma and acute care surgery
|March 24, 2025
概括
胆囊穿孔的早期腹腔镜胆囊切除术显著减少了住院总时间 (THLOS),但没有影响其他结果. 建议在入院后两天内进行迅速的手术干预,以改善患者管理.
科学领域:
- 手术成果研究的研究结果.
- 胃肠道手术 胃肠道手术
- 急性护理手术是急性护理手术.
背景情况:
- 胆囊穿孔是急性胆囊炎的严重并发症,死亡率高.
- 穿孔胆囊炎的管理策略缺乏可靠的证据,特别是关于操作时间的证据.
- 这项研究调查了早期与延迟胆囊切除术对患者结局的影响.
研究的目的:
- 评估早期 (<2天) 与延迟 (≥2天) 腹腔镜胆囊切除术和胆囊穿孔患者住院总时间 (THLOS) 之间的关联.
- 为了比较其他术后结局,包括并发症,再入院和重新手术率,在早期和延迟的外科干预之间.
- 为穿孔胆囊炎手术的最佳时间提供基于证据的建议.
主要方法:
- 分析国家外科质量改善计划数据库 (2012-2021年).
- 针对胆囊穿孔的紧急或紧急腹腔镜胆囊切除术的患者的鉴定.
- 用于比较早期和延迟胆囊切除组之间的THLOS的多变量回归模型,根据手术前败血症状态进行调整.
主要成果:
- 延迟胆囊切除术与显著更长的THLOS相关 (2.94天的增加,p < 0.05).
- 对于没有手术前败血症的患者,延迟手术导致THLOS (4.71天,p <0.05) 更大.
- 早期和延迟组之间在术后停留时间,30天并发症,再入院或重新手术率方面没有发现显著差异.
结论:
- 早期腹腔镜胆囊切除术 (入院后<2天) 与胆囊穿孔的住院总时间减少有关.
- 在其他关键的术后结果中,早期和延迟的外科治疗之间没有显著差异.
- 在入院后两天内进行早期手术可能对胆囊穿孔的患者有益.
相关概念视频
Esophageal Perforation-II: Clinical Manifestations and Management
29
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
29
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
38
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
38
Esophageal Perforation-I: Introduction
54
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
54


