Manger T, Fahlke J, Pross M, Fuhlroth J, Röhl F W, Lippert H
Klinik und Poliklinik für Chirurgie, Medizinische Fakultät Otto-von-Guericke-Universität, Magdeburg.
Zentralbl Chir. 1999;124(12):1121-9.
While laparoscopic cholecystectomy has become the procedure of choice for the elective treatment of symptomatic cholecystolithiasis the question whether patients with acute cholecystitis should be operated laparoscopically or conventionally is still debated. Nevertheless, more and more surgeons tend to use the laparoscopic approach even in patients with acute cholecystitis. Of 1006 laparoscopic cholecystectomies performed at our hospital 42 were done for acute cholecystitis. Conversion to an open procedure was necessary in only one patient because of severe inflammatory changes. The overall mortality was zero. The average age was 45.9 years for all patients and 50.4 years for those with acute cholecystitis. The average operating time in patients with acute cholecystitis was 81 minutes compared to 62 minutes in patients who underwent elective laparoscopic cholecystectomy. The complication rate and the average hospitalization time did not differ significantly between the two groups. Our own data as well as the data retrieved from the literature seem to indicate that laparoscopic cholecystectomy is superior to the open procedure in the treatment of acute cholecystitis. Prerequisite is that the operation is performed less than 72 hours after the onset of the symptoms by an experienced operating team and the readiness to convert to open procedure if necessary. Under those circumstances laparoscopic cholecystectomy seems to be the treatment of choice for acute cholecystitis.
虽然腹腔镜胆囊切除术已成为择期治疗有症状胆囊结石的首选术式，但对于急性胆囊炎患者是应行腹腔镜手术还是传统手术仍存在争议。然而，越来越多的外科医生甚至在急性胆囊炎患者中也倾向于采用腹腔镜手术方法。在我院进行的1006例腹腔镜胆囊切除术中，有42例是因急性胆囊炎而施行的。仅1例患者因严重炎症改变而有必要转为开腹手术。总体死亡率为零。所有患者的平均年龄为45.9岁，急性胆囊炎患者的平均年龄为50.4岁。急性胆囊炎患者的平均手术时间为81分钟，而择期腹腔镜胆囊切除术患者的平均手术时间为62分钟。两组之间的并发症发生率和平均住院时间没有显著差异。我们自己的数据以及从文献中检索到的数据似乎表明，在急性胆囊炎的治疗中，腹腔镜胆囊切除术优于开腹手术。前提是由经验丰富的手术团队在症状出现后72小时内进行手术，并且必要时随时准备转为开腹手术。在这些情况下，腹腔镜胆囊切除术似乎是急性胆囊炎的首选治疗方法。
