Akovbiantz A, Stoffel U, Wehrli H, Svarin I, Tedaldi R
Chirurgische Klinik, Stadtspital Waid, Zürich.
Schweiz Rundsch Med Prax. 1991 Aug 13;80(33):821-5.
Laparoscopic cholecystectomy is on the way to become the procedure of choice for treatment of uncomplicated cholelithiasis. First experiences are summarized: Within the first year after introduction 139 patients, 100 women and 39 men, have been treated by this novel technique. 33 open cholecystectomies were carried out in the same period. In addition to simple cholecystolithiasis 11 patients had prior biliary pancreatitis and/or sphincterotomy because of choledocholithiasis, 16 patients had suffered before from acute cholecystitis, 3 patients were operated on with the diagnosis of acute cholecystitis and 3 patients underwent simultaneous laparoscopic intervention. Seven times the laparoscopic procedure had to be converted into an open one because of intraoperative complications, twice because of a lesion to the common bile duct, three times because of intractable bleeding, once because of obscure anatomic conditions and once because of a technical failure in establishing the pneumoperitoneum. Four postoperative complications could be treated conservatively. In the average, patients complained about pain for 2 days, stayed in the hospital 4.4 days and assumed their usual activity after 13 days. An extension of indications for laparoscopic cholecystectomy should be sought stepwise according to gained experience. The problem of technical training of surgeons persists and must be solved in priority.
腹腔镜胆囊切除术正逐渐成为治疗单纯性胆结石的首选术式。现将初期经验总结如下：在该新技术引入后的第一年，共治疗了139例患者，其中女性100例，男性39例。同期进行了33例开腹胆囊切除术。除单纯胆囊结石外，11例患者曾有胆源性胰腺炎和/或因胆总管结石行括约肌切开术，16例患者既往有急性胆囊炎病史，3例患者因急性胆囊炎诊断而接受手术，3例患者同时接受了腹腔镜干预。由于术中并发症，7例腹腔镜手术不得不转为开腹手术，其中2例因胆总管损伤，3例因难以控制的出血，1例因解剖结构不清，1例因建立气腹技术失败。4例术后并发症可保守治疗。患者平均疼痛2天，住院4.4天，13天后恢复日常活动。应根据积累的经验逐步寻求扩大腹腔镜胆囊切除术的适应证。外科医生的技术培训问题依然存在，必须优先解决。
