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Autores
Orientador(es)
Resumo(s)
Introdução
A colecistectomia laparoscópica (CL) é, atualmente, a abordagem gold standard para o tratamento da litíase vesicular sintomática associando-se a numerosas vantagens comparativamente à abordagem clássica. No entanto, como qualquer procedimento cirúrgico, apresenta riscos de complicações de gravidade variada. A determinação do risco de CL complicada é importante permitindo ao cirurgião preparar a intervenção de modo a evitar tais complicações. Vários autores têm identificado fatores e proposto scores que permitem prever a dificuldade e tempo cirúrgicos. No entanto nenhum dos scores propostos ganhou aceitação suficiente para utilização quotidiana.
O objetivo do presente trabalho foi determinar os fatores pré-operatórios associados à CL eletiva complicada.
Métodos
Estudo transversal e retrospetivo dos doentes submetidos a CL eletiva na ULS de Castelo Branco no ano de 2016, baseado na análise dos processos clínicos. A análise estatística dos dados foi realizada no software SPSS 24.0®.
Resultados e Discussão
Foram incluídos 192 doentes. Houve um maior número de CL fáceis (52,1%). As cirurgias classificadas como difíceis associaram-se a mais complicações, realização de colangiografia intraoperatória e internamentos mais prolongados.
A GGT e a ALT mostraram melhor acuidade que o género, o score ASA, o aPTT, o ratio neutrófilos/linfócitos e os antecedentes pessoais de colecistite aguda. Os neutrófilos, embora com significado estatístico não apresentaram poder discriminativo.
Conclusão
O sexo masculino, score ASA, antecedentes pessoais de colecistite aguda, ratio neutrófilos/linfócitos, aPTT, GGT e ALT correlacionam-se com o grau de dificuldade da CL. Foi o primeiro estudo que correlaciona aPTT com o grau de dificuldade cirúrgica. A GGT e a ALT, encontram-se escassamente documentadas como fatores preditivos para CL difícil. Este estudo poderá permitir a criação de um novo score para avaliação do grau de dificuldade da CL eletiva na população portuguesa.
Introduction Laparoscopic cholecystectomy (LC) is the gold standard approach for sintomatic gallstones, being associated with numerous advantages compared to the classic approach. However, like any surgical procedure, this approach has risks of complications of varied severity. The avaluation of the risk of complicated LC is important, allowing the surgeon to prepare the intervention to avoid such complications. Several authors have identified factors and proposed scores that allow predictions of surgical difficulty and time. However, none of the proposed scores have gained sufficient acceptance for everyday use. The main goal of this study was the avaluation of preoperative factors associated with complicated elective LC. Methods Transversal and retrospective study of patients undergoing elective LC at the ULS de Castelo Branco over 2016. Data was collected by means of analysis of the clinical processes. Statistical data analysis was performed using SPSS Statistics 24.0® software. Results and Discussion Were included 192 patients. There was a greater number of easy LC (52,1%). Surgeries classified as difficult were associated with more complications, intraoperative cholangiography and longer hospitalizations. GGT and ALT showed better acuity than gender, ASA score, aPTT, neutrophil/lymphocyte ratio, and personal history of acute cholecystitis. Neutrophils, although with statistical significance, did not present discriminative power. Conclusion Male sex, ASA score, personal history of acute cholecystitis, neutrophil/lymphocyte ratio, aPTT, GGT and ALT correlate with the degree of difficulty of LC. This is the first study to correlate aPTT with the degree of surgical difficulty. GGT and ALT are poorly documented as predictive factors for difficult elective LC. This study may allow the creation of a new score to assess the degree of difficulty elective LC for the Portuguese population.
Introduction Laparoscopic cholecystectomy (LC) is the gold standard approach for sintomatic gallstones, being associated with numerous advantages compared to the classic approach. However, like any surgical procedure, this approach has risks of complications of varied severity. The avaluation of the risk of complicated LC is important, allowing the surgeon to prepare the intervention to avoid such complications. Several authors have identified factors and proposed scores that allow predictions of surgical difficulty and time. However, none of the proposed scores have gained sufficient acceptance for everyday use. The main goal of this study was the avaluation of preoperative factors associated with complicated elective LC. Methods Transversal and retrospective study of patients undergoing elective LC at the ULS de Castelo Branco over 2016. Data was collected by means of analysis of the clinical processes. Statistical data analysis was performed using SPSS Statistics 24.0® software. Results and Discussion Were included 192 patients. There was a greater number of easy LC (52,1%). Surgeries classified as difficult were associated with more complications, intraoperative cholangiography and longer hospitalizations. GGT and ALT showed better acuity than gender, ASA score, aPTT, neutrophil/lymphocyte ratio, and personal history of acute cholecystitis. Neutrophils, although with statistical significance, did not present discriminative power. Conclusion Male sex, ASA score, personal history of acute cholecystitis, neutrophil/lymphocyte ratio, aPTT, GGT and ALT correlate with the degree of difficulty of LC. This is the first study to correlate aPTT with the degree of surgical difficulty. GGT and ALT are poorly documented as predictive factors for difficult elective LC. This study may allow the creation of a new score to assess the degree of difficulty elective LC for the Portuguese population.
Descrição
Palavras-chave
Colecistectomia Laparoscópica Dificuldade Pré-Operatória Risco Cirúrgico