摘要
目的对比分析东京指南(2018)(TG 2018)与急诊普通外科(EGS)分级系统对急性胆囊炎患者腹腔镜胆囊切除术(LC)手术治疗结局评估价值。方法选取2020年3月至2023年6月安徽省安庆市立医院收治的急性胆囊炎患者179例作为研究对象进行顾性分析,患者均于本次住院期间行LC治疗。收集并记录患者临床资料、治疗结局,对比分析TG 2018与EGS分级系统不同分级患者治疗结局,对TG 2018分级及EGS分级系统进行定量评分,比较不同治疗结局患者定量评分差异,并采用受试者工作特征(ROC)曲线分析TG 2018、EGS分级对急性胆囊炎患者手术治疗结局的预测价值。结果参照TG 2018分级标准,179例患者中Ⅰ级31例、Ⅱ级112例、Ⅲ级36例。不同TG 2018分级患者的Child-Pugh分级、围术期并发症发生率、术后入住ICU率及术后住院时间比较,差异均有统计学意义(P<0.05)。参照EGS分级标准,179例患者中Ⅰ级97例、Ⅱ级53例、Ⅲ~Ⅴ级29例。不同EGS分级患者的Child-Pugh分级、手术情况、围术期并发症发生率、术后入住ICU率及术后住院时间比较,差异均有统计学意义(P<0.05)。不同手术情况患者TG 2018定量评分比较,差异无统计学意义(P>0.05),而LC中转开腹患者EGS定量评分显著高于单纯LC患者(P<0.05)。围术期并发症患者TG 2018定量评分、EGS定量评分均显著高于围术期无并发症患者(P<0.05);术后入住ICU患者TG 2018定量评分、EGS定量评分均显著高于术后未入住ICU患者(P<0.05);术后住院时间≥7 d患者TG 2018定量评分、EGS定量评分均显著高于术后住院时间<7 d患者(P<0.05)。TG 2018分级和EGS分级对患者LC中转开腹、围术期并发症、术后入住ICU及术后住院时间≥7 d预测ROC曲线下面积(AUC)分别为0.598(P>0.05)和0.745(P<0.05)、0.791(P<0.05)和0.747(P<0.05)、0.785(P<0.05)和0.782(P<0.05)及0.693(P<0.05)和0.610(P<0.05)。结论TG 2018分级系统及EGS分级系统对急性胆囊炎LC患者�
Objective To compare and analyze the evaluation value of the Tokyo Guidelines(2018)(TG 2018)and EGS grading system in the outcome assessment of laparoscopic cholecystectomy(LC)for patients with acute cholecystitis.Methods A total of 179 patients with acute cholecystitis admitted to our hospital from March 2020 to June 2023 were selected by retrospective analysis.All patients underwent LC during this hospitalization.Clinical data and treatment outcomes were collected and recorded.Quantitative scores were calculated on TG 2018 and EGS grading systems,and the differences in quantitative scores of patients with different treatment outcomes were compared.ROC curve was used to analyze the predictive value of TG 2018 and EGS grading on the outcome of surgical treatment.Results According to TG 2018 grading criteria,among 179 patients,31 cases were gradeⅠ,112 cases were gradeⅡ,and 36 cases were gradeⅢ.Significant differences in Child-Pugh classification,perioperative complication rate,postoperative ICU admission rate,and postoperative hospital stay were observed among different TG 2018 grades(P<0.05).According to EGS grading criteria,97 cases were gradeⅠ,53 cases were gradeⅡ,and 29 cases were gradesⅢ–Ⅴ.Significant differences in Child-Pugh grade,perioperative complication rate,postoperative ICU admission rate,and postoperative hospital stay were observed among different EGS grades(P<0.05).The AUC for LC conversion to laparotomy was 0.598(P<0.05)and 0.745(P<0.05)for TG 2018 and EGS grading,respectively;for perioperative complications,0.791(P<0.05)and 0.747(P<0.05);for postoperative ICU admission,0.785(P<0.05)and 0.782(P<0.05);and for postoperative hospital stay≥7 days,0.693(P<0.05)and 0.610(P<0.05)onclusion TG 2018 and EGS grading systems both have certain predictive value for treatment outcomes in LC patients with acute cholecystitis.However,TG 2018 has a lower predictive value for conversion from laparoscopy to laparotomy but provides diagnostic criteria and guides clinical decisions.Both systems have t
作者
张国平
汪东树
凌新建
李贺
章琪
潘书鸿
马军
张亚铭
ZHANG Guoping;WANG Dongshu;LING Xinjian;LI He;ZHANG Qi;PAN Shuhong;MA Jun;ZHANG Yaming(General Surgery Department,Anqing Municipal Hospital,Wuhu,Anhui 246000,China)
出处
《转化医学杂志》
2024年第4期499-504,515,共7页
Translational Medicine Journal
基金
安徽省卫生健康委科研项目(AHWJ2021b117)
安庆市科技局项目(2023Z1017)。
