Chok Kenneth Siu Ho, Yuen Wai Key, Lau Hung, Lee Francis, Fan Sheung Tat
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.
Asian J Surg. 2004 Oct;27(4):313-6. doi: 10.1016/S1015-9584(09)60058-0.
Laparoscopic cholecystectomy (LC) is now the procedure of choice for symptomatic gallbladder disease. Although many recent studies, mostly from abroad, report that it can be performed safely in the outpatient setting, the experience of outpatient LC in Hong Kong is still limited. This retrospective study evaluated the feasibility, safety and patient acceptance of outpatient LC in Hong Kong Chinese patients.
The data of 73 consecutive patients who had undergone outpatient LC between February 2000 and October 2002 in the Day Surgery Centre of Tung Wah Hospital were prospectively collected and reviewed. The selection criteria for patients undergoing outpatient LC included American Society of Anesthesiologists risk classification I or II, age less than 70 years, and the availability of a competent adult to accompany the patient home and look after them for 24 hours. No effort was made to exclude complicated cases. After assessment by the operating surgeon, patients were discharged from the Day Surgery Centre in the afternoon when their clinical condition satisfied pre-defined discharge criteria. All patients were followed up in the Day Surgery Centre in the first and fourth postoperative weeks.
The same-day discharge rate was 88% and the conversion rate was 4%. Six patients (8.2%) with uneventful LC required hospitalization after the procedure. There was no major complication and no unplanned admission. Two patients had port site wound infection requiring hospital admission at the first follow-up. Patient satisfaction was high, pain acceptance was good, and analgesic consumption was minimal. Mild fat intolerance was common in patients postoperatively (> 50%), but this had almost all resolved by postoperative week four. All patients were able to resume their usual daily activities within 2 weeks after surgery.
LC is a safe and feasible outpatient procedure in Hong Kong, with high levels of patient satisfaction. A prospective study with a larger patient population is warranted to verify whether it should be recommended as treatment for gallstone disease in selected patients in future.
腹腔镜胆囊切除术（LC）目前是有症状胆囊疾病的首选手术方式。尽管最近许多研究（大多来自国外）报告称该手术可在门诊环境中安全进行，但香港门诊LC的经验仍然有限。这项回顾性研究评估了香港中国患者门诊LC的可行性、安全性及患者接受度。
前瞻性收集并回顾了2000年2月至2002年10月间在东华医院日间手术中心接受门诊LC的73例连续患者的数据。接受门诊LC患者的选择标准包括美国麻醉医师协会风险分级为I或II级、年龄小于70岁，以及有能力的成年人陪伴患者回家并照顾其24小时。未刻意排除复杂病例。经手术医生评估后，患者在临床状况符合预先定义的出院标准时于下午从日间手术中心出院。所有患者在术后第一周和第四周在日间手术中心进行随访。
当日出院率为88%，中转率为4%。6例（8.2%）LC过程顺利的患者术后需要住院。无重大并发症，也无计划外入院情况。2例患者出现切口感染，在首次随访时需要住院。患者满意度高，疼痛接受度良好，镇痛药物消耗量极少。术后患者中轻度脂肪不耐受常见（>50%），但几乎所有患者在术后第四周时都已缓解。所有患者在术后2周内都能恢复日常活动。
在香港，LC是一种安全可行的门诊手术，患者满意度高。有必要进行一项纳入更多患者的前瞻性研究，以验证未来是否应推荐其作为特定患者胆结石疾病的治疗方法。
