https://scholars.lib.ntu.edu.tw/handle/123456789/540943
標題: | Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study | 作者: | Endo I. Takada T. Hwang T.-L. Akazawa K. Mori R. Miura F. Yokoe M. Itoi T. Gomi H. Chen M.-F. Jan Y.-Y. Ker C.-G. HSIU-PO WANG Kiriyama S. Wada K. Yamaue H. Miyazaki M. Yamamoto M. |
關鍵字: | Acute cholecystitis; Cholecystostomy; Comorbidity; Laparoscopic cholecystectomy | 公開日期: | 2017 | 出版社: | Blackwell Publishing Asia | 卷: | 24 | 期: | 6 | 起(迄)頁: | 346-361 | 來源出版物: | Journal of Hepato-Biliary-Pancreatic Sciences | 摘要: | Background: Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods: An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. Results: The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0–3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion: Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity. ? 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85020133825&doi=10.1002%2fjhbp.456&partnerID=40&md5=cc1d41f84ee2d143fbd697ea4cc433ac https://scholars.lib.ntu.edu.tw/handle/123456789/540943 |
ISSN: | 1868-6974 | DOI: | 10.1002/jhbp.456 | SDG/關鍵字: | acute cholecystitis; adult; aged; Article; body mass; Charlson Comorbidity Index; cholecystectomy; clinical practice; cohort analysis; comorbidity; conservative treatment; controlled study; disease severity; female; gallbladder drainage; human; Japan; jaundice; major clinical study; male; mortality; multicenter study; neurological complication; observational study; operation duration; prediction; respiratory failure; retrospective study; Taiwan; acute cholecystitis; clinical trial; comparative study; international cooperation; laparoscopic cholecystectomy; middle aged; multivariate analysis; predictive value; procedures; prognosis; risk assessment; severity of illness index; statistical model; survival rate; treatment outcome; very elderly; Aged; Aged, 80 and over; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Cohort Studies; Drainage; Female; Humans; Internationality; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate; Taiwan; Treatment Outcome |
顯示於: | 醫學系 |
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