Buhler L, Mentha G, Borst F, Roche B, Morel P, Rohner A
Département de Chirurgie, Clinique de Chirurgie Digestive, Hôpital Cantonal Universitaire de Genève, Suisse.
J Chir (Paris). 1992 Nov;129(11):466-70.
Cholecystectomy is the only effective treatment of gallbladder stones. A retrospective study was carried out on results of 658 cholecystectomies by laparotomy without choledochotomy performed between January 1987 and December 1989, to determine morbidity and mortality of elective and emergency surgery and by age. Operations for tumors of the gallbladder and choledolithiasis were not included in the analysis. During this period, cholecystectomy was performed electively in 387 cases and under emergency conditions in 261 patients. Mortality and post-operative morbidity were 0% and 14.7% respectively after elective surgery, increasing to 1.1% (Fisher = 0.0617) and 25.2 (p = 0.0004) respectively after emergency operations. This large increase in postoperative morbidity in urgent cases was due to an increase in systemic and not local complications, as a result of the higher proportion of emergency operations with advancing age. Since elective cholecystectomy is safe it can be proposed to patients with symptoms, including the elderly. It is difficult at present to compare results of cholecystectomy by laparotomy with those of laparoscopy since the average age of in the latter category is markedly lower and the number of acute cases still low. The principal advantage of celioscopy could be a long term reduction in systemic complications in emergency operations.
胆囊切除术是治疗胆囊结石的唯一有效方法。对1987年1月至1989年12月期间进行的658例未行胆总管切开术的开腹胆囊切除术的结果进行了回顾性研究，以确定择期手术和急诊手术的发病率及死亡率，并按年龄进行分析。胆囊肿瘤和胆管结石手术未纳入分析。在此期间，387例为择期胆囊切除术，261例为急诊手术。择期手术后死亡率和术后发病率分别为0%和14.7%，急诊手术后分别增至1.1%（费舍尔检验=0.0617）和25.2%（p=0.0004）。急诊病例术后发病率大幅上升是由于全身并发症而非局部并发症增加，这是因为随着年龄增长急诊手术比例更高。由于择期胆囊切除术是安全的，所以对于有症状的患者，包括老年人，都可以建议进行该手术。目前很难将开腹胆囊切除术的结果与腹腔镜胆囊切除术的结果进行比较，因为后者的平均年龄明显更低，急性病例数量仍然较少。腹腔镜检查的主要优势可能是能长期降低急诊手术中的全身并发症。
