背景:尽管腹腔镜胆囊切除术已成为治疗胆囊疾病的金标准,对于患有复杂胆囊疾病的患者,也可以使用开放方法。胆囊切除术后并发症在现有的英语科学文献中有很好的记载,但根据治疗这些并发症所需的干预等级,人们对此并没有很好的理解。
目的:根据改良的Clavien-Dindo分类(MCDC)系统,比较腹腔镜与开腹胆囊切除术的术后并发症。
方法:在普外科进行了一项回顾性研究,第三单元,拉合尔总医院,拉合尔,包括2021年7月1日至2021年12月31日期间手术的患者数据,经过部门批准#SU-III/73/LGH,日期为2022年4月1日。明确诊断为急性胆囊炎的患者,慢性胆囊炎,胆石症,胆囊十二指肠瘘包括在内,而胆总管结石和,胆囊癌被排除在本研究之外。80例患者符合纳入标准,开腹和腹腔镜胆囊切除术每组40例。年龄数据集的信息,性别,外科手术史,即时和迟来的结果,手术长度,并收集MCDC等级。低度并发症为I级和II级,而III至V级是高等级的。
结果:纳入患者的平均年龄为42.52±8.76岁和40.025±8.12岁,在开放和腹腔镜组中,有80%和90%的女性优势,分别。两组患者均发生Ⅰ级和Ⅱ级并发症,仅在接受开腹胆囊切除术的患者中使用III级。各组患者均未出现IV级或V级并发症。在接受腹腔镜胆囊切除术的40例患者中,35%的患者出现低度并发症,而40%的患者在开腹胆囊切除术后出现低度并发症,呼吸系统并发症是最常见的。2.5%的患者在开腹胆囊切除术后出现严重并发症,而腹腔镜手术后没有患者出现严重并发症。
结论:接受腹腔镜胆囊切除术的患者比接受开腹胆囊切除术的患者更不容易出现并发症,因此需要手术和非手术类型的低级干预。MCDC是评估手术并发症的有价值的工具,可以通过提供报告和比较并发症发生率的标准化方法来帮助改善患者的预后。
BACKGROUND: Though laparoscopic cholecystectomy has become a gold standard management technique for gallbladder diseases, an open approach can also be used for patients having complicated gallbladder disease. Post-cholecystectomy complications are well-documented in existing English scientific literature but are not well understood according to the grade of intervention required to treat those complications.
OBJECTIVE: To compare the postoperative complications of laparoscopic versus open cholecystectomy according to the modified Clavien-Dindo classification (MCDC) system.
METHODS: A retrospective study was conducted at the Department of General Surgery, Unit - III, Lahore General Hospital, Lahore, comprising the data of patients operated between July 01, 2021, and December 31, 2021, after departmental approval # SU-III/73/LGH, dated April 1, 2022. Patients with the definitive diagnosis of acute cholecystitis, chronic cholecystitis, cholelithiasis, and cholecysto-duodenal fistula were included, while cases of choledocholithiasis and, gall bladder carcinoma were excluded from this study. Eighty patients met the inclusion criteria, with 40 patients in each group of open and laparoscopic cholecystectomy. Information for the data set of age, gender, history of surgical procedure, immediate and late outcome, length of surgery, and MCDC grade were collected. Low-grade complications were Grade I and Grade II, while Grades III to V were high-grade.
RESULTS: The mean age of included patients was 42.52 ± 8.76 and 40.025 ± 8.12 years, in the open and laparoscopic group, with 80% and 90% female preponderance, respectively. Grade I and Grade II complications occurred in both groups of patients, with Grade III only in patients who underwent open cholecystectomy. None of the patients from each group developed Grade IV or Grade V complications. Among 40 patients who underwent laparoscopic cholecystectomy, 35% of the patients developed low-grade complications, whereas 40% of the patients developed low-grade complications after open cholecystectomy, with respiratory complications being the most common. High-grade complications after open cholecystectomy were found among 2.5% of patients, whereas no patients developed high-grade complications following the laparoscopic approach.
CONCLUSIONS: Patients who underwent laparoscopic cholecystectomy are less prone to develop complications than patients undergoing open cholecystectomy, hence requiring low-grade interventions of surgical and non-surgical types. MCDC is a valuable tool for assessing surgical complications and can help improve patient outcomes by providing a standardized method for reporting and comparing complication rates.