Panzera F, Ghisio S, Grosso A, Vigezzi P, Vitale M, Cariaggi R M, Mistrangelo M
Divisione di Chirurgia Generale, Presidio Ospedaliero di Santhià, Azienda Sanitaria n. 11, Vercelli.
Minerva Chir. 2000 Jul-Aug;55(7-8):489-92.
The many advantages and extreme versatility made laparoscopic cholecystectomy (L.C.) the gold standard for symptomatic cholelithiasis. The aim of this research is a retrospective analysis of personal experience with laparoscopic cholecystectomy in a peripheral hospital compared with the literature on the subject.
Since June 1982, a total of 989 L.C. have been performed. The patients were: 691 (68.6%) women and 298 (29.4%) men with a mean age of 56 years (range 17-84). The indications were: 791 symptomatic cholelithiasis, 142 chronic cholecystitis, 45 empyema-hydrops and 11 adenomyomatosis.
No postoperative death have been observed and the conversion rate was of 24 cases (2.3%). The main complications were 3 cases of injury of the biliary tract and 2 cases of postoperative bleeding (1 from cystic artery and 1 from the umbilical wound). Minor complications observed were 12 cases (1.2%) of infections of the umbilical wound and 3 cases of umbilical hernia (0.3%). The elevation of stasis index was observed in 3 cases which solved spontaneously. The length of stay was 2 days in 957 cases (97%), 8 days in 24 cases and 4-5 days in 8 (0.7%).
No major trochar's lesions occurred, contrary to the percentages quoted in the literature (0.02%-0.9%). The selective use of the open technique and of the multiuse conic section trocar in the "closed" technique is suggested. The 3 cases of bile duct lesions did not occur during the training period, contrary to what quoted in the literature. In personal opinion, a careful surgical technique with a good Calot's triangle preparation, is necessary to prevent these inconveniences. Parietal complications (umbilical wound infections and laparocele) even if lesser than in the laparotomy technique, can be reduced by using the endobag and suturing the abdominal fascia of the 10 mm trocars. Moreover, the use of a systematic subhepatic drainage during the first 24 postoperative hours is suggested, since it can be useful to reveal possible bleeding.
腹腔镜胆囊切除术（LC）具有诸多优点且用途广泛，已成为有症状胆结石治疗的金标准。本研究旨在回顾性分析一家基层医院的腹腔镜胆囊切除术个人经验，并与该主题的文献进行比较。
自1982年6月以来，共进行了989例LC手术。患者包括：691例（68.6%）女性和298例（29.4%）男性，平均年龄56岁（范围17 - 84岁）。手术适应症为：791例有症状胆结石、142例慢性胆囊炎、45例积脓 - 积水和11例腺肌增生症。
未观察到术后死亡病例，中转开腹率为24例（2.3%）。主要并发症为3例胆道损伤和2例术后出血（1例来自胆囊动脉，1例来自脐部伤口）。观察到的轻微并发症为12例（1.2%）脐部伤口感染和3例脐疝（0.3%）。3例出现淤滞指数升高，均自行缓解。957例（97%）患者住院时间为2天，24例为8天，8例（0.7%）为4 - 5天。
未发生主要的套管针损伤，与文献报道的百分比（0.02% - 0.9%）相反。建议在“闭合”技术中选择性使用开放技术和多用圆锥部套管针。3例胆管损伤并非发生在培训期间，与文献报道情况相反。个人认为，采用精细的手术技术并做好胆囊三角的准备工作，对于预防这些不便情况很有必要。腹壁并发症（脐部伤口感染和切口疝）即使比开腹手术少，但使用内袋并缝合10mm套管针处的腹横筋膜可减少此类并发症。此外，建议术后头24小时内进行系统性的肝下引流，因为这有助于发现可能的出血情况。
