Ferguson C M
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Am Surg. 1992 Feb;58(2):96-9.
Though laparoscopic cholecystectomy has become widespread, questions remain as to its success rate, its role in acute cholecystitis, the role of cholangiography, and whether laser use is necessary. To attempt to answer these questions, the first 100 patients undergoing laparoscopic cholecystectomy at Emory University using electrosurgical diathermy were reviewed. Patients underwent cholecystectomy for biliary colic (87), gallstone pancreatitis (1), and acute cholecystitis (12). The average length of hospital stay was 29 hours (range: 12 hours to 5 days). Laparoscopic cholecystectomy was not possible in 7 patients because of gangrenous cholecystitis (2), adhesions from previous surgery (2), equipment failure (2), and choledochoduodenal fistula found at surgery (1). Two patients developed bile leaks from accessory bile ducts that healed spontaneously. There were no other complications. The average time required to complete the laparoscopic cholecystectomy was 115 minutes (range: 45 to 238 minutes) and was not significantly different in those patients undergoing intraoperative cholangiography (117 minutes) versus those without (109 minutes). Common duct stones were uncommon in this series. Thirty-three patients underwent intraoperative cholangiogram. One patient was found to have a common duct stone, which was pushed into the duodenum using a Fogarty catheter (American Edwards Laboratories; Anasco, Puerto Rico) inserted through the cystic duct at the time of laparoscopic cholecystectomy. Twelve patients with acute cholecystitis underwent an attempt at laparoscopic cholecystectomy that was successful in nine. These procedures were difficult and lengthy (mean of 143 minutes). Causes for failure were gangrenous cholecystitis (2) and equipment failure (1). In conclusion, laparoscopic cholecystectomy can be performed with a high success rate (93%) and low morbidity (2%). No complications seemed attributable to electrosurgical dissection.
尽管腹腔镜胆囊切除术已广泛应用，但关于其成功率、在急性胆囊炎中的作用、胆管造影的作用以及是否有必要使用激光等问题仍然存在。为了试图回答这些问题，我们回顾了埃默里大学首批100例使用电外科透热法进行腹腔镜胆囊切除术的患者。患者因胆绞痛（87例）、胆石性胰腺炎（1例）和急性胆囊炎（12例）接受胆囊切除术。平均住院时间为29小时（范围：12小时至5天）。7例患者因坏疽性胆囊炎（2例）、既往手术粘连（2例）、设备故障（2例）以及手术中发现胆总管十二指肠瘘（1例）而无法进行腹腔镜胆囊切除术。2例患者出现副胆管胆汁漏，自行愈合。无其他并发症。完成腹腔镜胆囊切除术所需的平均时间为115分钟（范围：45至238分钟），术中进行胆管造影的患者（117分钟）与未进行胆管造影的患者（109分钟）之间无显著差异。本系列中胆总管结石并不常见。33例患者进行了术中胆管造影。1例患者被发现有胆总管结石，在腹腔镜胆囊切除术时通过胆囊管插入Fogarty导管（美国爱德华兹实验室；波多黎各阿纳斯科）将结石推入十二指肠。12例急性胆囊炎患者尝试进行腹腔镜胆囊切除术，9例成功。这些手术难度大且耗时较长（平均143分钟）。失败原因是坏疽性胆囊炎（2例）和设备故障（1例）。总之，腹腔镜胆囊切除术成功率高（93%）、发病率低（2%）。似乎没有并发症可归因于电外科剥离。
