Laparoscopic Cholecystectomy in Cardiogenic Shock And Heart Failure.

IF 1.1 4区 医学 Q3 SURGERY
Laurel Gieseke, Morgan Vonasek, Christine Lovato, Farah Husain, MacKenzie Landin
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引用次数: 0

Abstract

Background: Patients with cardiogenic shock (CS) or heart failure can develop ischemic cholecystitis from a systemic low-flow state. Cholecystectomy in high-risk patients is controversial. Percutaneous cholecystostomy tube (PCT) is often the chosen intervention; however, data on PCT as definitive treatment are conflicting. Data on cholecystectomy in these patients are limited. This study discusses outcomes following laparoscopic cholecystectomy (LC) in this patient population. Methods: This is a retrospective review of patients who underwent LC from 2015 to 2019 while hospitalized for CS or heart failure. Surgical services are provided by fellowship-trained minimally invasive surgeons at a single, academic, tertiary-care center. Patient characteristics are reported as frequencies' percentages for categorical variables. Odds ratio is used to determine the association between comorbidities and complications. Results: Twenty-four patients underwent LC. Around 83% were white and 79% were male. Many were anticoagulated (88%), with Class IV heart failure (63%), and required vasopressors (46%) at the time of surgery. Fourteen of 24 (58%) had at least one circulatory device at the time of surgery: extracorporeal membrane oxygenation, left ventricular assist device, Impella, tandem heart, and total artificial heart. Four patients (17%) had PCT preoperatively. Fifteen days were the average interval between diagnosis and surgery. Pneumoperitoneum was tolerated by all, and 0% converted to open. Most common complication was bleeding (52%). Nine patients (37.5%) underwent 21 reoperations, one of which (4%) was related to cholecystectomy. Mortality occurred in 5 patients (20.8%); interval between cholecystectomy and mortality ranged 6-30 days. Conclusion: Although high risk, LC is a treatment option in patients with ischemic cholecystitis at risk for death from sepsis.

心源性休克和心力衰竭患者的腹腔镜胆囊切除术
背景:心源性休克(CS)或心力衰竭患者会因全身低血流状态而发生缺血性胆囊炎。对高危患者进行胆囊切除术存在争议。经皮胆囊造瘘管(PCT)通常是首选的介入治疗方法;然而,有关 PCT 作为最终治疗方法的数据却相互矛盾。有关此类患者胆囊切除术的数据也很有限。本研究讨论了此类患者行腹腔镜胆囊切除术(LC)后的疗效。方法:这是对 2015 年至 2019 年期间因 CS 或心力衰竭住院接受 LC 的患者进行的回顾性研究。手术服务由一家学术性三级医疗中心接受过研究员培训的微创外科医生提供。患者特征以分类变量的频数和百分比表示。用比值比来确定合并症与并发症之间的关系。结果:24名患者接受了LC。约 83% 为白人,79% 为男性。许多患者进行了抗凝治疗(88%),患有 IV 级心衰(63%),手术时需要使用血管加压药(46%)。24 位患者中有 14 位(58%)在手术时至少使用了一种循环装置:体外膜氧合、左心室辅助装置、Impella、串联心脏和全人工心脏。四名患者(17%)在术前使用了 PCT。诊断与手术之间的平均间隔时间为 15 天。所有患者都能耐受腹腔积气,0%的患者转为开腹手术。最常见的并发症是出血(52%)。九名患者(37.5%)接受了 21 次再次手术,其中一次(4%)与胆囊切除术有关。5名患者(20.8%)出现了死亡;胆囊切除术与死亡之间的间隔时间为6-30天。结论:尽管风险很高,但对于有脓毒症死亡风险的缺血性胆囊炎患者来说,LC 是一种治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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