急性胆囊炎に対する治療指針―全身麻酔可能と判断される場合には準緊急で腹腔鏡下胆囊摘出術を施行する―の検討

eng=Background : Our current therapeutic criterion for acute cholecystitis is : Perform a subemergency laparoscopic cholecystectomy (LC) when a patient is judged to be able to tolerate general anesthesia. The aim of the current study was to verify whether this criterion is justified. Methods : The outcomes of 21 cases of LC for acute cholecystitis performed between April 2011 and September 2013 were retrospectively analyzed. Subemergency LC was performed according to the aforementioned criterion (Subemergency group ; n = 16). Patient who was judged to be unable to tolerate general anesthesia underwent percutaneous transhepatic gallbladder drainage (PTGBD) first, then LC after the patients\u27 condition became stable (PTGBD group ; n = 5). Results : There is no conversion to open surgery throughout the study period. The mean of the total hospital stays in the Subemergency group was significantly shorter than that in the PTGBD group (11.5 ± 5.3 vs. 30.4 ± 8.5 days). Although two patients in the Subemergency group, who had already needed oxygen administration preoperatively, suffered postoperative respiratory failure, they completely recovered. On the other hand, there is no postoperative complication in the PTGBD group. Discussion : Subemergency LC could be safely performed when surgeons as well as anesthesiologists judged a patient to be able to tolerate general anesthesia, which significantly shorten hospital stays compared to elective LC after PTGBD. However, elective LC after PTGBD is an absolutely safer therapeutic option in treating unstable patients.【背景】急性胆囊炎に対する現在の我々の治療方針は“全身麻酔可能と判断される場合には準緊急で腹腔鏡下胆囊摘出術を行う”である. この治療方針の正当性を検証した. 【方法】2011年4月から2013年9月までに行った急性胆囊炎に対する腹腔鏡下胆囊摘出術症例21例を対象とした. 準緊急腹腔鏡下胆囊摘出術は上記の治療指針に従って行った（準緊急群 ; n = 16）. 全身麻酔が安全に施行できないと判断された場合には経皮経肝胆囊ドレナージを行い, 全身状態が安定した後に腹腔鏡下胆囊摘出術を行った（PTGBD群 ; n = 5）. 【結果】全症例に対して腹腔鏡で胆囊摘出術を完遂した. 平均総入院日数はPTGBD群と比較して準緊急群で有意に短かった（11.5 ± 5.3 対30.4 ± 8.5 日）. 準緊急群では術前に既に酸素投与を必要としていた2例に術後の呼吸不全を認め, 術後に人工呼吸管理を必要とした. 一方PTGBD群では術後合併症を1例も認めなかった. 【結語】急性胆囊炎に対する準緊急腹腔鏡下胆囊摘出術は, 全身麻酔が可能と判断される場合には安全に施行することができ, 早期の退院が可能であった. 状態が不安定で全身麻酔が安全に施行することが難しいと判断される患者においてはPTGBDを施行した後, 状態が安定してから腹腔鏡下胆囊摘出術を行うことが絶対的に安全と考えられた

Verification of Our Therapeutic Criterion for Acute Cholecystitis : "Perform a Subemergency Laparoscopic Cholecystectomy when a Patient is Judged to be able to Tolerate General Anesthesia" - The Experience in a Single Community Hospital

eng=Background : Our current therapeutic criterion for acute cholecystitis is : Perform a subemergency laparoscopic cholecystectomy (LC) when a patient is judged to be able to tolerate general anesthesia. The aim of the current study was to verify whether this criterion is justified. Methods : The outcomes of 21 cases of LC for acute cholecystitis performed between April 2011 and September 2013 were retrospectively analyzed. Subemergency LC was performed according to the aforementioned criterion (Subemergency group ; n = 16). Patient who was judged to be unable to tolerate general anesthesia underwent percutaneous transhepatic gallbladder drainage (PTGBD) first, then LC after the patients' condition became stable (PTGBD group ; n = 5). Results : There is no conversion to open surgery throughout the study period. The mean of the total hospital stays in the Subemergency group was significantly shorter than that in the PTGBD group (11.5 ± 5.3 vs. 30.4 ± 8.5 days). Although two patients in the Subemergency group, who had already needed oxygen administration preoperatively, suffered postoperative respiratory failure, they completely recovered. On the other hand, there is no postoperative complication in the PTGBD group. Discussion : Subemergency LC could be safely performed when surgeons as well as anesthesiologists judged a patient to be able to tolerate general anesthesia, which significantly shorten hospital stays compared to elective LC after PTGBD. However, elective LC after PTGBD is an absolutely safer therapeutic option in treating unstable patients.【背景】急性胆囊炎に対する現在の我々の治療方針は“全身麻酔可能と判断される場合には準緊急で腹腔鏡下胆囊摘出術を行う”である. この治療方針の正当性を検証した. 【方法】2011年4月から2013年9月までに行った急性胆囊炎に対する腹腔鏡下胆囊摘出術症例21例を対象とした. 準緊急腹腔鏡下胆囊摘出術は上記の治療指針に従って行った（準緊急群 ; n = 16）. 全身麻酔が安全に施行できないと判断された場合には経皮経肝胆囊ドレナージを行い, 全身状態が安定した後に腹腔鏡下胆囊摘出術を行った（PTGBD群 ; n = 5）. 【結果】全症例に対して腹腔鏡で胆囊摘出術を完遂した. 平均総入院日数はPTGBD群と比較して準緊急群で有意に短かった（11.5 ± 5.3 対30.4 ± 8.5 日）. 準緊急群では術前に既に酸素投与を必要としていた2例に術後の呼吸不全を認め, 術後に人工呼吸管理を必要とした. 一方PTGBD群では術後合併症を1例も認めなかった. 【結語】急性胆囊炎に対する準緊急腹腔鏡下胆囊摘出術は, 全身麻酔が可能と判断される場合には安全に施行することができ, 早期の退院が可能であった. 状態が不安定で全身麻酔が安全に施行することが難しいと判断される患者においてはPTGBDを施行した後, 状態が安定してから腹腔鏡下胆囊摘出術を行うことが絶対的に安全と考えられた