Stair J M, DeLoach J M, Woodward L A, Ludwig F R
Pulaski Surgery Clinic, North Little Rock, Arkansas.
J Ark Med Soc. 1991 Jul;88(2):83-5.
It would seem that laparoscopic laser cholecystectomy is a safe and reasonable procedure. We feel that it will be indicated for most patients with symptomatic gallbladder disease. The only distinct contraindications which we have noted are multiple prior upper abdominal procedures, common bile duct obstruction, or intense acute inflammation. However, as experience has widened, even some of the above problems may be manageable with laparoscopic technique. We would expect that the technique can be attempted on at least 90% of patients with proven gallbladder disease and that this percentage may increase with further experience. Our experience suggests that there is probably no increased operative risk with this operation. Any potential risks associated with pneumoperitoneum and introduction of laparoscopic instruments is more than offset by higher morbidity associated with open techniques. Besides the obvious economic benefits of shorter hospital stay and recovery time and rapid return to self-care and employment, this operation is quite rewarding for both surgeon and patient due to the decrease in post-operative pain and discomfort and a striking decrease in pulmonary problems, phlebitis and other complications of more invasive procedures. We expect this to become the standard procedure for gallbladder disease as experienced is widened.
看来腹腔镜激光胆囊切除术是一种安全且合理的手术。我们认为，大多数有症状胆囊疾病的患者都适合该手术。我们所注意到的唯一明确的禁忌症是既往多次上腹部手术、胆总管梗阻或严重急性炎症。然而，随着经验的增加，即使上述一些问题也可以通过腹腔镜技术来处理。我们预计，至少90%确诊胆囊疾病的患者可以尝试该技术，并且随着经验的进一步积累，这一比例可能会增加。我们的经验表明，该手术可能不会增加手术风险。与气腹和腹腔镜器械置入相关的任何潜在风险，都被开放手术相关的更高发病率所抵消。除了住院时间缩短、恢复时间加快以及能迅速恢复自我护理和工作等明显的经济效益外，由于术后疼痛和不适的减轻以及侵入性更强的手术中肺部问题、静脉炎和其他并发症的显著减少，该手术对外科医生和患者来说都很有意义。随着经验的增加，我们预计这将成为胆囊疾病的标准手术。
