Abstract：
BACKGROUND: Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for low-risk acute cholecystitis (AC); however, some patients undergo delayed LC (DLC) after conservative treatment. DLC, influenced by chronic inflammation, is a difficult procedure. Previous studies on LC difficulty lacked objective measures. Recently, TG18 introduced a novel 25 findings difficulty score, which objectively assesses intraoperative factors. The purpose of this study was to use the difficulty score proposed in TG18 to identify and investigate the predictors of preoperative high-difficulty cases of DLC for AC.
METHODS: We retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A-C.
RESULTS: The severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC.
CONCLUSIONS: The difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.
METHODS: We retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A-C.
RESULTS: The severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC.
CONCLUSIONS: The difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.
摘要：
背景：2018年东京指南（TG18）建议对低风险急性胆囊炎（AC）进行早期腹腔镜胆囊切除术（LC）；但是，一些患者在保守治疗后接受延迟LC(DLC).DLC,受慢性炎症的影响，是一个困难的程序。以前关于LC困难的研究缺乏客观的措施。最近,TG18引入了一个新颖的25个发现难度评分，客观评估术中因素。这项研究的目的是使用TG18中提出的难度评分来识别和研究术前高难度DLC病例的预测因子。
方法：我们回顾性分析了100例保守AC治疗后的DLC患者。使用难度评分评估DLC的手术难度。根据以前的研究，每个类别中的最高分被归类为A-C级。
结果：51例患者AC的严重程度为轻度，49例患者为中度。手术结果显示难度分数的分布，C级表示难度高，显示手术时间的显著差异，失血,实现安全的批判性观点，救助程序，和术后住院时间与A级和B级相比，关于术前危险因素，多变量分析确定年龄>61岁(p=.008)，体重指数>27.0kg/m2（p=.007），胆囊壁厚>6.2mm（p=.001）是DLCC级的独立危险因素。
结论：TG18中提出的难度评分为评估手术难度提供了客观框架，允许在DLC中进行更准确的风险评估并改进AC的术前计划。
方法：我们回顾性分析了100例保守AC治疗后的DLC患者。使用难度评分评估DLC的手术难度。根据以前的研究，每个类别中的最高分被归类为A-C级。
结果：51例患者AC的严重程度为轻度，49例患者为中度。手术结果显示难度分数的分布，C级表示难度高，显示手术时间的显著差异，失血,实现安全的批判性观点，救助程序，和术后住院时间与A级和B级相比，关于术前危险因素，多变量分析确定年龄>61岁(p=.008)，体重指数>27.0kg/m2（p=.007），胆囊壁厚>6.2mm（p=.001）是DLCC级的独立危险因素。
结论：TG18中提出的难度评分为评估手术难度提供了客观框架，允许在DLC中进行更准确的风险评估并改进AC的术前计划。
