Kimura K, Ido K, Taniguchi Y, Kawamoto C, Satoh S, Isoda N, Ohtani M, Kumagai M, Horikawa S
Department of Gastroenterology, Jichi Medical School, Tochigi-ken, Japan.
Endoscopy. 1992 Nov;24(9):740-4. doi: 10.1055/s-2007-1010575.
Two hundred and fifty consecutive patients (151 women, 99 men, age 49.3 years) with symptomatic gallstones as diagnosed on ultrasonography underwent elective laparoscopic cholecystectomy over a 12-month period. Preoperative intravenous cholangiography (IVC) and endoscopic retrograde cholangiography (ERC) were also performed in 203 and 200 patients, respectively. Laparoscopic cholecystectomy was successfully performed on 248 of the 250 patients (99.2%). Two patients required conversion to open cholecystectomy because of a pin hole injury to the portal vein in one case, and because of technical difficulties with the dissection due to severe adhesions in the other patient. Procedure time in the initial 100 cases decreased from an average of 216 minutes for the first ten cases to 87 minutes for the last 30 cases, including the time required for intraoperative cholangiography (IOC). Bile duct stones were found in 4 cases on IOC which were diagnosed by preoperative ultrasonography, IVC and ERC in 0, 2 and 3 cases respectively. An intraabdominal drain was inserted for two days in all cases. The mean hospital stay was 8.6 days (range 4 to 19 days) with no readmissions. No complications were seen at short-term follow-up one month after discharge. Although there was a significant learning period, the procedure was safe and effective and could be performed with minimal risk. The results show that physicians with experience in both endoscopy and laparoscopy are well qualified to perform laparoscopic cholecystectomy after appropriate training.
250例经超声诊断为有症状胆结石的连续患者（151例女性，99例男性，年龄49.3岁）在12个月期间接受了择期腹腔镜胆囊切除术。分别有203例和200例患者还进行了术前静脉胆管造影（IVC）和内镜逆行胆管造影（ERC）。250例患者中有248例（99.2%）成功进行了腹腔镜胆囊切除术。2例患者因1例门静脉针孔损伤以及另1例患者因严重粘连导致解剖困难而需要转为开腹胆囊切除术。最初100例手术的时间从最初10例的平均216分钟降至最后30例的87分钟，包括术中胆管造影（IOC）所需时间。IOC检查发现4例胆管结石，术前超声、IVC和ERC分别诊断出0例、2例和3例。所有病例均放置腹腔引流管两天。平均住院时间为8.6天（4至19天），无再次入院情况。出院后1个月的短期随访未发现并发症。尽管有一个明显的学习期，但该手术安全有效，且风险极小。结果表明，经过适当培训后，有内镜和腹腔镜经验的医生完全有资格进行腹腔镜胆囊切除术。
