早期胆囊切除术治疗有严重合并症的胆囊炎患者。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-08-29 DOI:10.1016/j.hpb.2025.08.012

Erik Osterman, Olov Norlén, Fredrik Linder

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引用次数: 0

摘要

背景：本研究旨在探讨早期胆囊炎手术严重合并症患者的围手术期和术后并发症。方法：采用来自瑞典胆囊切除术登记、国家患者登记、国家处方药登记和国家死因登记的32,463例胆囊炎急诊手术患者的数据。采用logistic回归计算并发症的优势比（OR）。评估严重合并症（ASA3）与健康（ASA1-2）患者的具体术后并发症。结果：ASA3的围手术期（OR 1.24, 95%可信区间1.04 ~ 1.48）和术后并发症（OR 1.21, 95%可信区间1.13 ~ 1.3）较ASA1-2多见。在年龄70 ~ 70岁、等待时间5天和腹腔镜手术的亚组分析中，ASA3术后并发症的OR保持稳定。ASA3患者行开放手术后并发症的OR为1.12（95%可信区间0.96-1.32）。严重合并症患者增加最多的并发症是胆漏、出血和感染。ASA3与ASA1-2的严重并发症（需要干预或ICU住院）的OR为1.69（95%可信区间1.47-1.94）。结论：ASA3患者术后并发症风险增加。更好的围手术期护理可以降低这些患者的风险。

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Early cholecystectomy for cholecystitis in patients with severe comorbidity.

Background: This study aimed to investigate peri- and postoperative complications in severely comorbid patients undergoing early surgery for cholecystitis.

Methods: Data for 32,463 patients who had emergency surgery for cholecystitis from the Swedish Cholecystectomy Registry, National Patient Register, National Prescribed Drug Register and the National Cause of Death Register were used. The odds ratios (OR) for complications were calculated using logistic regression. Specific postoperative complications were assessed for severely comorbid (ASA3) versus healthy (ASA1-2) patients.

Results: It was more common with perioperative (OR 1.24, 95 % confidence interval 1.04-1.48) and postoperative complications (OR 1.21, 95 % confidence interval 1.13-1.3) in ASA3 than ASA1-2. The OR for postoperative complications in ASA3 remained stable in subgroup analyses of age >70, >5 days wait time and laparoscopic surgery. The OR for postoperative complications in ASA3 patients undergoing open surgery was 1.12 (95 % confidence interval 0.96-1.32). The complications that increased most in severely comorbid patients were bile leakage, bleeding and infection. The OR for severe complications (requiring intervention or ICU admission) was 1.69 (95 % confidence interval 1.47-1.94) in ASA3 versus ASA1-2.

Conclusion: ASA3 patients had an increased risk of postoperative complications. Better perioperative care may reduce the risk for these patients.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).