ABSTRACT
Objective:To investigate the efficacy of early versus delayed laparoscopic cholecystectomy (LC) in the treatment of acute calculous cholecystitis complicated by abnormal liver function. Methods:A total of 106 patients with acute calculous cholecystitis complicated by abnormal liver function who received LC in Nanjing Drum Tower Hospital, Nanjing University Medical School, China between February 2018 and February 2020 were included in this study. They were assigned to receive laparoscopic cholecystectomy either within 72 hours after disease onset (early group, n = 51) or 72 hours after disease onset (delayed group, n = 51). Perioperative indexes, complications, immune function and liver function were compared between the two groups. Results:Intraoperative blood loss in the early group was less than that in the delayed group [(63.11 ± 8.18) mL vs. (92.39 ± 7.23) mL, t = 19.558, P < 0.001]. Operative time, time to anal exhaust and length of hospital stay in the early group were (49.53 ± 6.33) minutes, (23.24 ± 4.65) hours and (6.38 ± 1.23) days in the early group were significantly shorter than those in the delayed group [(63.24 ± 5.42) minutes, (32.88 ± 5.78) hours, (8.34 ± 1.54) days, t = 12.004, 9.415, 7.204, all P < 0.001]. There was no significant difference in the rate of conversion to open cholecystectomy during LC between the two groups ( χ2 = 0.877, P > 0.05). There was no significant difference in the incidence of complications between early and delayed groups [11.76% (6/51) vs. 7.27% (4/55), χ2 = 0.625, P > 0.05]. On day 3 after surgery, the proportion of CD 3+ cells and the ratio of CD 4+/CD 8+ cells in the early group were (37.81 ± 4.29) % and (1.32 ± 0.29), respectively, which were significantly higher than those in the delayed group [(32.56 ± 5.26) %, 1.21 ± 0.23, t = 5.605, 6.379, both P < 0.001]. Total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (21.05 ± 5.16) μmol/L, (71.58 ± 9.36) U/L and (175.73 ± 19.64) U/L, respectively, which were significantly lower than those in the delayed group [(27.81 ± 5.14) μmol/L, (82.54 ± 12.35) U/L, (214.62 ± 20.58) U/L, t = 6.921, 7.893, 9.865, all P < 0.001]. On day 5 after surgery, total bilirubin, alanine aminotransferase and alkaline phosphatase levels in the early group were (14.63 ± 4.58) μmol/L, (42.13 ± 8.24) U/L, (137.72 ± 17.62) U/L, respectively, which were significantly lower than those in the delayed group [(18.67 ± 6.45) μmol/L, (59.64 ± 11.29) U/L, (162.76 ± 18.39) U/L, t = 3.692, 8.265, 7.462, all P < 0.001]. Conclusion:Early LC for treatment of acute calculous cholecystitis complicated by abnormal liver function can effectively promote the recovery of liver function, mitigate immune injury, improve perioperative indicators, and dose not increase the incidence of complications.
ABSTRACT
Objective To explore the feasibility and efficiency of laparoscopic surgery for the treatment of acute biliary pancreatitis (ABP) at early stage. Methods From January 2003 to June 2006, 18 patients with ABP received laparoscopic surgeries, including laparoscopic cholecystectomy (LC) in 3, LC combined with laparoscopic common bile duct exploration (LCBDE) in 9, LC combined with opening of the pancreatic capsule for drainage in 5, and LC combined with LCBDE and opening of the pancreatic capsule for drainage in 1. Results In all the patients, the laparoscopic operations were completed successfully without conversion to open surgery. The operation time was 100-150 min with a mean of (115.3?15.2) min. The stones in the bile duct were removed completely by LCBDE in 10 patients. No subcutaneous emphysema, hemorrhage, abdominal abscess or stenosis of the bile duct occurred in this series. The 18 patients were followed up for 4-40 months (mean, 28.5 months), during which 2 patients developed pancreatic pseudocyst. One of the patients was cured by internal drainage. In the other patient, the pseudocyst was absorbed spontaneously. No recurrence of pancreatitis or common bile duct stones was found. Conclusions Laparoscopic surgery is minimally invasive and effective for the treatment of ABP at early stage.