급성 담낭염에서 복강경 담낭절제술시 적절한 수술 시기에 관한 연구

Abstract

Purpose : Laparoscopic cholecystectomy has been performed even in case of acute cholecystitis and GB empyema with increasing experience of laparoscopic surgery. Many previous studies has been recommended early laparoscopic cholecystectomy in acute cholecystitis. Methods : From February, 1997 to January, 2000, 364 patients were attempted to laparoscopic cholecystectomy and 71 patients of them were attempted to laparoscopic cholecystectomy due to acute cholecytitis. They were divided into 4 groups based on the time of operation form the onset of symptom. These groups were compared in conversion rate and postoperative clinical outcomes, such as operation time, time of bowel movement, starting diet, starting soft diet and discharge. The affecting factors on conversion were analyzed (age, sex, fever, murphy sign, accompanying pancreatitis, SGOT/SGPT, alkaline phosphatase, GB wall thickening, WBC count). Results : Among 71 patients who were attempt to laparoscopic cholecystectomy in acute cholecystitis, 20 patients (28.1%) required converting to open surgery. There were no statistically significant difference in clinical outcomes and conversion rate between four groups (p>0.568). In univariate analyis, high frequency of conversion to open surgery in acute cholecystitis was observed in male (p=0.012). Conclusion : Even though conversion rate to open surgery is still high in acute cholecystitis, the time of laparoscopic surgery in acute cholecystits does not affect on the conversion rate and postoperative clinical outcomes. Consider-ing of the hospital stay and its related economic problems, laparoscopic cholecystectomy should be attempted as soon as possible without hesitation. It may be due to advanced laparoscopic techniques and experiences.