Brandon J C, Velez M A, Teplick S K, Mueller P R, Rattner D W, Broadwater J R, Lang N P, Eidt J F
Department of Radiological Sciences, University of California Irvine, Orange 92668.
AJR Am J Roentgenol. 1991 Aug;157(2):235-9. doi: 10.2214/ajr.157.2.1830188.
Laparoscopic cholecystectomy, a surgical technique first performed in France, has gained widespread acceptance among surgeons in the United States. The abdominal cavity is inflated by carbon dioxide, a video monitor is inserted via a laparoscope placed periumbilically, and the gallbladder is freed and removed from the liver bed by using small subcostal ports for access and dissection. Intraoperative cholangiography is routinely performed, but uncertainty exists about how best to manage choledocholithiasis. Compared with traditional cholecystectomy, initial reports describing laparoscopic cholecystectomy cite shorter recovery times because no large incisions are made, thus potentially reducing the cost and morbidity of cholecystectomy. A survey of 614 early cases supports these claims, with a reported complication rate of 1.5% and quick resumption of normal activities by patients. Because of its promise for reduced morbidity, laparoscopic cholecystectomy is challenging open cholecystectomy as the therapeutic gold standard for symptomatic cholelithiasis. Thus, the standard to which the nonsurgical gallstone therapies, such as lithotripsy and contact dissolution, will be compared may shift to laparoscopic cholecystectomy. As the laparoscopic complications are similar to those of traditional cholecystectomy, such as abscesses and bile leaks, their percutaneous treatment should not change.
腹腔镜胆囊切除术是一种最早在法国开展的外科技术，已在美国外科医生中得到广泛认可。通过二氧化碳使腹腔膨胀，经脐部放置的腹腔镜插入视频监视器，然后通过肋缘下的小切口进入并进行解剖，将胆囊从肝床上游离并切除。术中常规进行胆管造影，但对于如何最佳处理胆总管结石仍存在不确定性。与传统胆囊切除术相比，最初描述腹腔镜胆囊切除术的报告称恢复时间更短，因为无需做大切口，从而可能降低胆囊切除术的成本和发病率。一项对614例早期病例的调查支持了这些说法，报告的并发症发生率为1.5%，患者能很快恢复正常活动。由于其有望降低发病率，腹腔镜胆囊切除术正在挑战开放胆囊切除术作为有症状胆结石治疗金标准的地位。因此，诸如碎石术和接触溶解术等非手术胆结石治疗方法与之比较的标准可能会转向腹腔镜胆囊切除术。由于腹腔镜手术的并发症与传统胆囊切除术相似，如脓肿和胆漏，其经皮治疗方法不应改变。
