McGee J M, Randel M A, Morgan R M, Nolen M G, Weaver G E, Malnar K F, Yamanashi W S, Lytle G H
University of Oklahoma College of Medicine, Department of Surgery, Tulsa.
J Laparoendosc Surg. 1992 Dec;2(6):293-302. doi: 10.1089/lps.1992.2.293.
The initial 950 consecutive laparoscopic cholecystectomies performed in one city at four hospitals by 30 general surgeons are reported, covering a period from April 4, 1990 to April 3, 1991. There were two operative deaths (0.2%), three common bile duct lacerations (0.3%), two subhepatic abscesses, two bowel perforations, and three bile leaks, two requiring laparotomy. Seven episodes of bleeding occurred, of which five required laparotomy, but none involved a major vessel. Sixty-five procedures were converted to open (6.7%). The mean operative time was 85.4 min. Intraoperative cholangiography was adequately completed in 49.8% and not attempted in 30.3%. Thirteen patients (2.7%) were found to have common duct stones. The pathologic diagnoses were chronic cholecystitis in 784 patients (82.5%), acute cholecystitis in 145 (15.3%), and cancer of the gallbladder in one (0.1%). Hospital stays ranged from 4 h to 31 days (mean 49.5 h). This procedure can be learned and performed safely in a community setting.
报告了30位普通外科医生于1990年4月4日至1991年4月3日期间在一个城市的四家医院连续进行的最初950例腹腔镜胆囊切除术。有2例手术死亡（0.2%），3例胆总管撕裂（0.3%），2例肝下脓肿，2例肠穿孔，3例胆漏，其中2例需要开腹手术。发生了7次出血事件，其中5次需要开腹手术，但均未涉及大血管。65例手术转为开腹手术（6.7%）。平均手术时间为85.4分钟。术中胆管造影成功完成的比例为49.8%，未尝试的比例为30.3%。13例患者（2.7%）被发现有胆总管结石。病理诊断为慢性胆囊炎784例（82.5%），急性胆囊炎145例（15.3%），胆囊癌1例（0.1%）。住院时间从4小时到31天不等（平均49.5小时）。该手术可以在社区环境中学习并安全实施。
