정승규·이상목·고영관·홍성화·주흥재
경희대학교
의과대학 외과학교실
Clinical
Usefulness of Emergency Laparoscopic Cholecystectomy for
the Patient with Acute Cholecystitis
Seung
Kyu Jeong, M.D., Sang Mok Lee, M.D., Young Gwan Ko, M.D.
Sung
Wha Hong, M.D., Hoong Zae Joo, M.D.
Department
of Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
This
study was designed to evaluate the therapeutic significance of emergency laparoscopic
cholecystectomy in acute cholecystitis. Two hundred and thirty-seven patients who
underwent laparoscopic cholecystectomy at the Department of General Surgery Kyunghee
University Hospital from July l995 to December l996 were analyzed retrospectively.
In
this study, the patients were classified into two groups; the emergency group that
underwent emergency laparoscopic cholecystectomy and the elective group that underwent
elective laparoscopic cholecystectomy, Twenty-one patients(8,9%) comprised the emergency
group and 216 patients(91.1%) were in the elective group. Emergency laparoscopic
cholecystectomy was performed under the following conditions: (l) acute cholecystitis
without improvement of symptoms after conservative management over 24 hours; (2)
those ultrasonographically diagnosed as GB empyema, gangrenous GB, or perforated
GB. Clinical features, operative time, conversion rate, post-operative complications,
and postoperative hospital stay were compared. The most common disease was GB empyema
in the emergency group (l3 cases, 61.9%) and chronic cholecystitis in the elective
group (192 cases, 88.9%). There were no differences in age and sex distribution.
As compared to the elective group; the mean operative time was significantly longer
in the emergency group (p<0.05), l43 min. vs 94 min.; no significant difference
in the postoperative hospital stay, 4.9 days vs 3.8 days(p>0.05); the post-operative
complications were significantly more common in the emergency group(p<0.05),
23.8%(5 cases) vs 4.1%(9 cases); no significant difference in the conversion rate(p>0.05),
0% vs l.9%(4 cases).
In
conclusion, emergency laparoscopic cholecystectomy may be a safe and useful method
for acute chloecystitis in spite of longer operative time and more common post-operative
complications as compared to elective laparoscopic cholecystectomy because it, has
the advantages of laparosopic surgery.
Key
Words: Acute cholecystitis, Laparosopic cholecystectomy |
