Berbig R, Muller C
Chirurgische Klinik, Spital Uster.
Helv Chir Acta. 1992 May;58(6):983-6.
In the beginnings of laparoscopic cholecystectomy a severe pathological alteration of the gallbladder or stones of the common bile duct were regarded as relative contraindications to the method. However increasing experience and improve technic have shown, that even a severe pathology of the gallbladder such as chronic cholecystitis with wall thickening, acute or subacute inflammation or a porcelaine gallbladder can be laparoscopically managed. Operation time in such cases is longer, but median hospital stay is the same as in uncomplicated cases. However postoperative morbidity may be increased. For patients with CBD stones preoperative ERCP with papillotomy followed by laparoscopic cholecystectomy some days later offers a treatment with low morbidity and optimal comfort for the patient.
在腹腔镜胆囊切除术开展初期，胆囊的严重病理改变或胆总管结石被视为该手术方法的相对禁忌证。然而，随着经验的不断积累和技术的改进，已表明即使是胆囊的严重病变，如伴有胆囊壁增厚的慢性胆囊炎、急性或亚急性炎症或瓷化胆囊，也可通过腹腔镜进行处理。这类病例的手术时间较长，但中位住院时间与非复杂病例相同。不过，术后发病率可能会增加。对于患有胆总管结石的患者，术前进行内镜逆行胰胆管造影（ERCP）及乳头切开术，数日后再行腹腔镜胆囊切除术，可为患者提供一种发病率低且舒适度高的治疗方法。
