Shamiyeh Andreas, Wayand Wolfgang
Ludwig Boltzmann Institute for Operative Laparoscopy and Second Surgical Department, Academic Teaching Hospital, Linz, Austria.
Dig Dis. 2005;23(2):119-26. doi: 10.1159/000088593.
Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out.
A Medline, PubMed, Cochrane search.
Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is 'therapeutic splitting' with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay.
The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.
腹腔镜胆囊切除术（LC）是胆结石疾病的标准手术。本综述的目的是根据现有文献，审视这种微创技术与传统手术相比的优势和益处。根据循证医学标准，梳理了腹腔镜在治疗胆囊结石、胆囊炎和胆总管结石方面的现状。
进行Medline、PubMed、Cochrane检索。
有10项随机对照试验（RCT）比较了腹腔镜胆囊切除术与开腹胆囊切除术。结果表明LC在术后疼痛较轻、恢复较快和住院时间较短方面具有优势。在LC开展的最初几年，手术时间较长。3项RCT涉及急性胆囊炎：一篇论文未发现LC相对于传统胆囊切除术有任何显著优势，另外两篇则发现LC在恢复、住院时间和术后疼痛方面有好处。择期手术的中转率在5%至7%之间，急性胆囊炎的中转率则高达27%。在欧洲，超过90%的胆总管结石标准手术是术前通过内镜和逆行胰胆管造影进行“治疗性分离”，随后进行LC。在经验丰富的医生手中，腹腔镜胆管清理术是有效且安全的，然而，唯一已证实的益处是住院时间略短。
在择期胆囊切除术和急性胆囊炎中，腹腔镜手术方式更受青睐。这种微创技术已被证明是有效、温和且安全的。主要益处体现在术后最初几天。
