Perri S, Amendolara M, Gallo G, Valenti G, Meneghini G, Gelmi G F
Divisione di Chirurgia Generale, Stabilimento Ospedaliero di Montecchio Maggiore (VI).
G Chir. 1992 Nov-Dec;13(11-12):557-64.
The management of calculous disease of the gallbladder has undergone significant change during the last decade. Recent years have seen the development of alternative methods for the treatment of biliary stones including dissolution therapy, endoscopic and percutaneous extraction, extracorporeal shock wave lithotripsy. Yet, despite these technologic advances, most surgeons have continued to consider cholecystectomy the safest, most effective and the only curative procedure. Open cholecystectomy, performed in the same fashion for more than a century has demonstrated low morbidity and minimal mortality rates. However, the operation does incur sizable expense in terms of hospitalization, cosmetic appearance and time lost from work. Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. The authors report their experience of laparoscopic cholecystectomy performed at the Surgical Department of Montecchio Maggiore Hospital (VI). Twenty-eight patients were operated on: in all but one laparoscopic cholecystectomy was successfully completed; in one case a fistula between gallbladder and the common bile duct led to T-tube drainage insertion via a laparotomy. In one patient laparoscopic cholecystectomy was performed after an endoscopic retrograde cholangio-sphincterotomy for associated stones of the common bile duct. Mean operative time was 69 minutes (range 46-210). Morbidity and mortality were 0%; maximal hospital stay was 48 hours. These data confirm that laparoscopic cholecystectomy may be considered the treatment of choice for stone disease of the gallbladder and it should enter into the cultural and technical background of a general surgeon.
在过去十年中，胆囊结石病的治疗方法发生了重大变化。近年来，出现了多种治疗胆结石的替代方法，包括溶石疗法、内镜及经皮取石术、体外冲击波碎石术。然而，尽管有这些技术进步，大多数外科医生仍认为胆囊切除术是最安全、最有效且唯一能治愈的手术。一个多世纪以来，开放式胆囊切除术一直以相同方式进行，其发病率低，死亡率极低。然而，该手术在住院费用、美观以及误工时间方面确实会产生相当大的代价。腹腔镜胆囊切除术迅速成为开放式胆囊切除术的替代选择。作者报告了他们在蒙特基奥马焦雷医院（VI）外科进行腹腔镜胆囊切除术的经验。共对28例患者进行了手术：除1例患者外，其余所有患者的腹腔镜胆囊切除术均成功完成；1例患者因胆囊与胆总管之间形成瘘管，通过剖腹手术插入了T形管引流。1例患者在进行内镜逆行胆管括约肌切开术治疗胆总管相关结石后接受了腹腔镜胆囊切除术。平均手术时间为69分钟（范围46 - 210分钟）。发病率和死亡率均为0%；最长住院时间为48小时。这些数据证实，腹腔镜胆囊切除术可被视为胆囊结石病的首选治疗方法，并且应成为普通外科医生知识和技术储备的一部分。
