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The degree of gallbladder wall thickness and its impact on outcomes after laparoscopic cholecystectomy

机译：腹腔镜胆囊切除术后胆囊壁厚度的程度及其对预后的影响

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Background: Laparoscopic cholecystectomy is the goldstandard procedure for management of symptomatic gallstone disease. Increased rates of conversion to an open procedure, increased postoperative complications, and longer lengths of stay are seen in thick-walled gallbladders. Previous studies have only evaluated gallbladder walls as being thick or not thick, without looking at the degree of thickness. We hypothesized that, the more severe the wall thickening, the greater the chance of conversions and complications, and the longer the lengths of stay. Methods: All attempted laparoscopic cholecystectomies in our institution between 2006 and 2009 were retrospectively reviewed. Patients undergoing cholecystectomy for reasons other than gallstones (e.g., polyps or cancer) and those without preoperative ultrasounds were excluded. Patients were divided into four groups based on the degree of gallbladder wall thickness: normal (1-2 mm), mildly thickened (3-4 mm), moderately thickened (5-6 mm), and severely thickened (7 mm and above). Outcomes were compared amongst the groups. Results: 874 patients were included in the study. There were 68 conversions (7.8 %) and 58 complications (6.6 %). The incidence of conversions was 3.1, 5.1, 14.9, and 16.8 % in the four groups, respectively (p 0.001, χ2), and the incidence of complications was 1.8, 6.7, 9.1, and 13.1 %, respectively (p = 0.001, χ2). The mean (± standard deviation, SD) length of stay in days was 1.09 ± 1.42, 1.83 ± 3.24, 2.54 ± 3.40 and 3.54 ± 4.61, respectively [p 0.001, analysis of variance (ANOVA)]. Conclusions: A greater degree of gallbladder wall thickness is associated with an increased risk of conversion, increased postoperative complications, and longer lengths of stay. Classifying patients according to degree of gallbladder wall thickness gives more accurate assessment of the risk of surgery, as well as potential outcomes.
机译：背景：腹腔镜胆囊切除术是管理有症状胆结石疾病的金标准程序。在厚壁胆囊中，转换为开放手术的比率增加，术后并发症增加，住院时间更长。以前的研究仅评估胆囊壁是厚的还是不厚的，而没有考虑厚度。我们假设，壁增厚越严重，转化和并发症的机会就越大，并且住院时间越长。方法：回顾性分析2006年至2009年在我院进行的所有腹腔镜胆囊切除术尝试。排除因胆结石以外的原因而进行胆囊切除术的患者（例如息肉或癌症）以及未进行术前超声检查的患者。根据胆囊壁厚的程度将患者分为四组：正常（1-2 mm），轻度增厚（3-4 mm），中度增厚（5-6 mm）和重度增厚（7 mm及以上） 。在各组之间比较结果。结果：874名患者被纳入研究。共有68例转化（7.8％）和58例并发症（6.6％）。四组的转换发生率分别为3.1％，5.1％，14.9％和16.8％（p <0.001，χ2），并发症的发生率分别为1.8％，6.7％，9.1％和13.1％（p = 0.001， χ2）。平均天停留时间（±标准偏差，SD）分别为1.09±1.42、1.83±3.24、2.54±3.40和3.54±4.61 [p <0.001，方差分析（ANOVA）]。结论：更大程度的胆囊壁厚与转换风险增加，术后并发症增加以及住院时间更长有关。根据胆囊壁厚度的程度对患者进行分类，可以更准确地评估手术风险以及潜在的结局。

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