급성 화농성 담낭염에 있어서 개복수술과 비교한 복강경 담낭절제술의 장점
The Comparative Analysis of Laparoscopic & Open Cholecystectomy for the Acute Suppurative Cholecystitis
김대동, 강구정, 임태진,
소속 상세정보
김대동 ( )
계명대학교 의과대학 외과학교실
강구정 ( )
계명대학교 의과대학 외과학교실
임태진 ( )
계명대학교 의과대학 외과학교실
KMID : 0978820010040010001
Abstract
목적: 담낭 급성 화농성 담낭염에서의 복강경 담낭절제술과 개복술의 수술 수술결과를 토대로 수술시간, 입원기간의 차이 및 술 중 및 술후 합병증을 비교하여 장단점을 비교하고자 하였다. 대상 및 방법: 1996년 2월부터 2001년 4월까지 본원에서
담낭절제술을 받은 환자중 술중 소견 및 조직학적 검사상, 급성 화농성 담낭염으로 진단된 환자 103명의 환자를 대상으로 수술시간, 술후 입원기간, 담석의 유무 및 개수, 개복술로의 전환율, 술후 합병증을 후향적으로 분석하였다. 결과: 담낭 급성 화농성
담낭염에서 복강경 담낭절제술을 시행한 군에서 수술시간과 술후 입원기간이 짧았으나 합병증 빈도에는 차이가 없었고 개복전환율은 35.7%로 다소 다른 보고에 비하여 다소 높았으나 다른 보고에 비하여 더 심한 염증소견을 대상으로 연구되었기 때문으로 여겨진다.
결론: 급성 화농성 담낭염에 있어서 복강경적 담낭절제술은 개복 담낭절제술에 합병증의 차이가 없되 수술시간이나 재원기간이 단축되고 경미한 창상 및 빠른 정상생활로의 복귀 등의 장점을 보여 숙련된 외과의에 의해 시행되어진다면 담낭 급성 화농성
담낭염에서
복강경적 담낭절제술이 표준적인 치료방법으로 추천될만하다고 생각된다.
Backgrounding/Aims: The laparoscopic cholecystectomy(LC) has been accepted as the procedure of choice for cholecystitis although there are some limitations for patients who have severe cardiovascular and pulmonary dysfunction. But for
acute
suppurative cholecystitis, the safety and efficacy of LC has not been fully determined. Thus we designed this study to assess the clinical outcomes of LC for acute suppurative cholecystitis to evaluate it's efficacy, safety and advantages over
open
cholecystectomy(OC).
Methods: We retrospectively analyzed 103 consecutive patients who met criteria of acute suppurative cholecystitis or empyema of their gallbladder by gross examination intraoperatively and/or postoperative histopathologic examination during
the
period from February 1996 to April 2001. During the early phase of this period, the rate of OC was higher, but later more patient were allocated to the LC by experienced surgeons. We compared the clinical outcomes such as mean hospital stay,
duration
of surgery, and complication rate between LC and OC group. The patients who converted to OC were grouped to OC for analysis of clinical outcomes.
Results: LC was successful in 36 out of 56 patients and OC was done in 47 patients. Twenty(35.7%) patients in the LC group required conversion to OC. The LC and OC group were similar in demographic, physical and clinical characteristics.
The
mean duration of surgery was 102.0 minutes in LC and 132.6 minutes in OC group(p<0.05) and postoperative hospital stay was 7.7 versus 13.5 days in LC and OC respectively (p<0.05). The complication rate was 16.7%(6/36) in LC and 20.9%(14/67) in
OC(p>0.05).
Conclusion: LC is feasible for most of the patients who have acute suppurative cholecystitis with acceptable complications and less duration of surgery and less hospital stay in comparison to the clinical outcomes of OC for the patients
who
have
similar clinical characteristics.
키워드
Laparoscopic cholecystectomy; Acute suppurative cholecystitis;
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