摘要
Abstract
Objective To evaluate the feasibility and safety of an ambulatory surgery model for emergency cholecystitis.Methods A retrospective analysis was conducted in 206 acute cholecystitis patients,who underwent laparoscopic cholecystectomy(LC)in the First Affiliated Hospital of Wenzhou Medical University from Jan.2022 to Jan.2025.Based on hospitalization management models,patients were categorized into the ambulatory surgery group(n=96)and the inpatient surgery group(n=110).Propensity score matching(PSM)was applied for 1:1 matching between the two groups.Baseline characteristics before PSM and after PSM,perioperative indicators,postoperative complication incidence rates,and the readmission rates within 30 d postoperatively,were compared between two groups.Results Before PSM,compared with the ambulatory surgery group,patients in the inpatient surgery group were with older age,higher Charlson comorbidity index,higher degree of inflammation,thicker gallbladder walls,wider range of pericholecystic exudate,higher rates of cystic duct/ampullary stone impaction,and higher proportions of moderate acute cholecystitis(P<0.05).After PSM,82 patients were included in each group,with balanced baseline characteristics(P>0.05).After PSM,compared with the inpatient surgery group,the patients in ambulatory group were with shorter time from outpatient to LC,lower rates of intraoperative drainage tube placement,lower VAS scores 6 h postoperatively,and shorter postoperative and total hospitalization time(P<0.05).By indocyanine green fluorescence navigation and drainage management,some cases with complex medical conditions could achieve ambulatory discharge.No statistically significant difference was found in terms of postoperative complication incidence rates or readmission rates within 30 d postoperatively between the groups(P>0.05).Conclusion With process optimization and technological innovation,the ambulatory surgery model can significantly shorten the time from outpatient to LC and hospitalization time of emergency cholecystitis patients,reduce the rate of intraoperative drainage tube placement,alleviate postoperative pain,and the safety is controllable.关键词
急性胆囊炎/急诊手术/日间手术模式/腹腔镜胆囊切除术/倾向性评分匹配/可行性/安全性Key words
acute cholecystitis/emergency surgery/ambulatory surgery model/laparoscopic cholecystectomy/propensity score matching/feasibility/safety分类
临床医学
