Fitzgibbons R J, Schmid S, Santoscoy R, Tyndall S, Hinder R, Filipi C J, Jenkins J, Fitzgibbons R J, Salerno G M
Creighton University School of Medicine, Departments of Surgery and Gastroenterology, Omaha, Nebraska.
Surg Laparosc Endosc. 1991 Dec;1(4):216-22.
This report deals with the first 350 laparoscopic cholecystectomies performed at Creighton University, beginning in October 1989, by one of the authors (R.J.F., Jr.). An open technique was used for initial access to the abdominal cavity in 343 patients (98%). Patients included 274 females and 76 males, with an average age of 45.5 years. Weight ranged from 72 to 316 pounds (32-142.2 kg). The laparoscopic procedure was successfully completed in 338 (96.6%). Operative cholangiography was performed in 113 (32.3%), and 52 (14.7%) had acute cholecystitis as determined by the final pathological report. Median operating time was 80 min. There was no operative mortality. Bile duct injury was not seen. Postoperative complications occurred in 21 patients (6%), only two of which were directly related to the open technique (cellulitis of the umbilical wound requiring antibiotics). A third patient (0.3% of 343 successful laparoscopies) required reoperation on postoperative day 4 for a small bowel perforation; the exact cause could not be determined, but conceivably it was related to the umbilical minilaparotomy. We conclude that the open technique is safe and effective method for initial peritoneal access prior to laparoscopic cholecystectomy.
本报告涉及1989年10月起由作者之一（小R.J.F.）在克里顿大学进行的首例350例腹腔镜胆囊切除术。343例患者（98%）采用开放技术作为进入腹腔的初始方法。患者包括274名女性和76名男性，平均年龄45.5岁。体重范围为72至316磅（32 - 142.2千克）。338例（96.6%）成功完成了腹腔镜手术。113例（32.3%）进行了术中胆管造影，最终病理报告显示52例（14.7%）患有急性胆囊炎。中位手术时间为80分钟。无手术死亡病例。未发现胆管损伤。21例患者（6%）出现术后并发症，其中只有2例与开放技术直接相关（脐部伤口蜂窝织炎需使用抗生素）。第3例患者（343例成功腹腔镜手术中的0.3%）术后第4天因小肠穿孔需要再次手术；确切原因无法确定，但可能与脐部小切口剖腹术有关。我们得出结论，开放技术是腹腔镜胆囊切除术之前初始进入腹腔的一种安全有效的方法。
