男性、年長等因素增加膽囊併發症風險


  【24drs.com】針對一間非教學醫院單一手術小組進行的腹腔鏡膽囊切除術(LCs),一項10年回溯評估提供了實際狀況的一些寫照。
  
  作者們在文章中指出,這篇報告是來自單一非教學醫院的最大型研究,刊載於7/8月版的Journal of Laparoendoscopic and Advanced Surgical Techniques。
  
  土耳其伊斯坦堡Umraniye教育與研究醫院一般外科Mustafa Hasbahceci醫師等人寫道,腹腔鏡膽囊切除術被視為膽結石治療的黃金標準,但因多數臨床回顧合併了不同醫院的手術團隊以及外科醫師,或單一機構的多名外科醫師或團隊的結果,以致於難以獲得手術結果的實際面貌;而且,在教學醫院和非教學醫院的比較方面,也不清楚併發症比率,特別是膽管損傷。
  
  為了釐清這些議題,作者們回顧了2000年1月至2010年10月間,在土耳其伊斯坦堡29 May醫院、土耳其宗教基金會進行的所有腹腔鏡膽囊切除術病例;結果測量包括:轉為開腹手術、手術時間、住院天數與住院期間到出院3個月後發生的併發症,全部病患在術後追蹤至少3個月。
  
  研究分析1,557名病患,包括1,222名女性和335名男性,平均年紀54.1 ± 12.3歲,76%病患的身體質量指數(BMI)介於25 kg/m2和34.99 kg/m2;大多數手術(1401例[90%])是選擇性進行,191例(12%)患者曾發生過急性膽囊炎(AC),34人(2%)曾發生過急性膽源性胰腺炎。
  
  手術時間範圍為10-200分鐘,平均43.4分鐘,85.8%案例的手術時間小於60分鐘;住院天數平均為1.2天(範圍1 – 19天),93.1%的病患在手術後1天內出院,94.8%的病患在2天內出院。
  
  有39例需要轉為開腹手術,轉換率為2.5%。最常見的轉換原因,是有許多和目前或以前的急性膽囊炎發作有關的發炎,分別有17例(43.5%)和15例(38.5%),轉換術式的其他原因包括:膽管損傷(n = 3人)、之前手術導致的緻密沾黏(n = 2人)以及設備故障(n = 2人)。
  
  作者們寫道,總計51名病患發生57例(3.7%)併發症,最常見的併發症為感染相關(11名病患)、膽汁漏出(n = 10人)、出血(n = 7人)、總膽管殘餘結石(n = 6人)、術後麻痺性腸梗塞(n = 6人)以及術後腹水(n = 4人)。
  
  作者們報告指出,與轉換為開腹手術機率較高的相關因素包括:男性(勝算比[OR]4.473;P < .001)、55歲以上(OR,2.478;P < .01)、因為急性膽囊炎導致急診住院(OR = 558.263;P < .001)、曾發生過急性膽囊炎(OR,4.766;P < .001)。和發病率有關的風險因素包括:男性(OR,1.813;P < .046)、美國麻醉科醫師協會分數3分(OR,3.706;P < .005)、因為急性膽囊炎急診住院(OR,7.034;P < .001)、曾發生過急性膽囊炎(OR,3.378;P < .001)。
  
  作者們指出,其他作者曾報告過的併發症比率範圍從1.5%到高達17%皆有,根據的因素包括:出現複雜性膽結石疾病、男性、年長、需轉為開腹手術、手術時間大於2小時、是否在教學醫院進行。與之前文獻的併發症比率相比,其研究發現的3.7%併發症比率或許可視為可接受的結果。
  
  可能的研究限制包括,回溯型研究設計,在這段期間於該機構實際進行腹腔鏡膽囊切除術的1,676名病患中有119人的資料不完整,導致需將這些病患排除於分析。
  
  研究者結論表示,他們的結果或許可作為未來在單一非教學醫院進行腹腔鏡膽囊切除術之研究的比較基礎。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6908&x_classno=0&x_chkdelpoint=Y
  

Male Sex, Older Age Raise Risk for Gallbladder Complications

By Norra MacReady
Medscape Medical News

August 10, 2012 — A 10-year retrospective review of laparoscopic cholecystectomies (LCs) performed by a single surgical group at a non–teaching hospital provides a snapshot of that surgery under real-life conditions.

This report is one of the largest to come from a single non–teaching hospital, the authors explain in their article, which was published in the July/August issue of the Journal of Laparoendoscopic and Advanced Surgical Techniques.

LC is considered the gold standard for gallstone treatment, but it is hard to obtain a true picture of outcomes because most clinical reviews combine the findings either of multiple studies of different surgeons and surgical groups at several hospitals or of multiple surgeons and groups at a single institution over time, lead author Mustafa Hasbahceci, MD, from the Department of General Surgery, Umraniye Education and Research Hospital, Umraniye, Istanbul, Turkey, and colleagues write. It is also unclear how the rate of complications, particularly bile duct injury, at teaching hospitals compares with that seen at non–teaching hospitals.

In an effort to clarify these issues, the authors reviewed all LC procedures performed between January 2000 and October 2010 at the Religious Foundation of Turkey, 29 May Hospital, in Istanbul. Outcome measures included conversion to open surgery, surgery duration, length of hospital stay, and complications that occurred during hospital admission and up to 3 months out. All patients were followed-up for at least 3 months postoperatively.

The analysis included 1557 patients: 1222 women and 335 men, with an average age of 54.1 ± 12.3 years. Seventy-six percent of the patients had a body mass index (BMI) of between 25 kg/m2 and 34.99 kg/m2. Most of the procedures (1401 [90%]) were performed electively. One hundred and ninety one (12%) of the patients had had a previous attack of acute cholecystitis (AC), and 34 (2%) had a history of acute biliary pancreatitis.

The duration of surgery ranged from 10 to 200 minutes, with a mean of 43.4 minutes. Surgery lasted less than 60 minutes in 85.8% of the cases. The mean length of hospital stay was 1.2 days (range, 1 - 19 days), with 93.1% of patients discharged within 1 day of surgery and 94.8% of patients discharged within 2 days.

Open surgery was required in 39 cases, for a conversion rate of 2.5%. Severe inflammation related to current or previous AC attacks was the most common reason for conversion, seen in 17 (43.5%) and 15 (38.5%) patients respectively. Bile duct injury (n = 3), dense adhesions resulting from previous surgery (n = 2), and equipment failure (n = 2) were other reasons for conversion.

"In total, 57 (3.7%) complications occurred in 51 patients," the authors write. The most common complications were those related to infection (seen in 11 patients), biliary leakage (n = 10), bleeding (n = 7), retained stones in the common bile duct (n = 6), postoperative paralytic ileus (n = 6), and postoperative ascites (n = 4).

Factors associated with a higher probability of conversion to open surgery were male sex (odds ratio [OR], 4.473; P < .001), age older than 55 years (OR, 2.478; P < .01), emergency admission resulting from AC (OR = 558.263; P < .001), and a history of previous AC attacks (OR, 4.766; P < .001), the authors report. Risk factors associated with morbidity included male sex (OR, 1.813; P < .046), an American Society of Anesthesiologists score of 3 (OR, 3.706; P < .005), emergency admission because of AC (OR, 7.034; P < .001), and a history of previous AC attacks (OR, 3.378; P < .001).

Other authors have reported complication rates ranging from 1.5% to as high as 17%, depending on factors such as the presence of complicated gallstone disease, male sex, advanced patient age, need for conversion to open surgery, duration of surgery more than 2 hours, and whether the procedure was performed at a teaching hospital, the authors add. "Our 3.7% complication rate may be considered a favorable result compared with the...complication rate found in the past literature."

Possible limitations of this study include the retrospective design and incomplete data on 119 of the 1676 patients who actually underwent LC at this institution during the time in question, leading to the exclusion of those patients from the analysis.

"Our results may serve as a baseline for comparison with future studies done at single, non-teaching hospitals where surgical teams perform laparoscopic cholecystectomies over a long period of time," the investigators conclude.

The authors have disclosed no relevant financial relationships.

J Laparoendosc Adv Surg Tech. 2012;22:527-532.

    
相關報導
Ursodeoxycholic Acid防止胃間隔手術後的膽結石
2003/11/17 上午 10:49:00
膽結石與使用Tamoxifen之間的關係
2003/5/13 上午 09:24:00

上一頁
   1  
下一頁




回上一頁