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腹腔镜胆囊切除术的并发症

Complications of laparoscopic cholecystectomy.

作者信息

Smith E B

机构信息

St Francis Medical Center, Pittsburgh, Pennsylvania.

出版信息

J Natl Med Assoc. 1992 Oct;84(10):880-2.

Abstract

Laparoscopic cholecystectomy with lasers or cautery is a feasible, effective, and worthwhile operative procedure that is subject to morbidity and mortality. There is unequivocal evidence that the complication incidence is directly related to the training and experience of the surgeon, applicability of basic principles of gallbladder and common duct surgery, and preventive measures toward iatrogenic injuries in gallbladder surgery. Continued and sustained investigation in laparoscopic cholecystectomy, technological developments in equipment, and the continued education of the surgeon in the applicability and use of laparoscopic cholecystectomy, intraoperative cholangiography, and choledocholithotomy are essential. At the St Francis Medical Center, Pittsburgh, Pennsylvania 1009 laparoscopic cholecystectomies with lasers or cautery were performed between March 1989 and October 1991. There were 32 (3%) abandoned laparoscopic cholecystectomies with alternative open cholecystectomy. There were six extrahepatic ductal injuries and a complication incidence of 10.9%. The mortality rate was 0.38%. The average length of stay was 2 days. In comparison with standard cholecystectomy, laparoscopic cholecystectomy is a competitive and superior procedure in selected circumstances.

摘要

采用激光或电灼的腹腔镜胆囊切除术是一种可行、有效且值得施行的手术,但存在发病和死亡风险。有明确证据表明,并发症发生率与外科医生的培训和经验、胆囊及胆总管手术基本原则的适用性以及胆囊手术中对医源性损伤的预防措施直接相关。对腹腔镜胆囊切除术进行持续且深入的研究、设备的技术发展以及对外科医生进行腹腔镜胆囊切除术、术中胆管造影和胆总管切开取石术的适用性及使用方法的继续教育至关重要。在宾夕法尼亚州匹兹堡的圣弗朗西斯医疗中心,1989年3月至1991年10月间共进行了1009例采用激光或电灼的腹腔镜胆囊切除术。其中有32例(3%)放弃腹腔镜胆囊切除术而改行开腹胆囊切除术。发生了6例肝外胆管损伤,并发症发生率为10.9%。死亡率为0.38%。平均住院时间为2天。与标准胆囊切除术相比,腹腔镜胆囊切除术在某些特定情况下是一种具有竞争力且更优越的手术。

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Laparoscopic cholecystectomy. Threat or opportunity?腹腔镜胆囊切除术。威胁还是机遇?
Arch Surg. 1990 Oct;125(10):1245. doi: 10.1001/archsurg.1990.01410220029002.
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Laparoscopic cholecystectomy: passing fancy or legitimate treatment option?
Gastroenterology. 1990 Nov;99(5):1527-9. doi: 10.1016/0016-5085(90)91190-h.
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Endoscopic cholecystectomy: a new approach.
Todays OR Nurse. 1990 Aug;12(8):17-20.

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