Bailey R W, Zucker K A, Flowers J L, Scovill W A, Graham S M, Imbembo A L
Department of Surgery, University of Maryland, School of Medicine, Baltimore.
Ann Surg. 1991 Oct;214(4):531-40; discussion 540-1. doi: 10.1097/00000658-199110000-00017.
Three hundred seventy-five consecutive patients underwent laparoscopic cholecystectomy from September 1989 to January 1991. Three hundred forty-one (91%) presented on an elective basis, and the remaining 34 patients (9%) were admitted for acute cholecystitis (24), gallstone pancreatitis (9), and cholangitis (1). Of the 375 patients, 20 were converted to laparotomy and cholecystectomy, for an overall success rate of 95% for patients undergoing laparoscopic cholecystectomy. Three hundred nineteen patients (90%) were discharged within 24 hours of surgery. Operative cholangiography was completed in 141 patients, showing choledocholithiasis in five (managed by postoperative endoscopic retrograde cholangiopancreatography [ERCP] in 4, common bile duct exploration [CBDE] in 1). Two retained stones (0.9%) were detected in 214 patients not undergoing cholangiography. Three patients (0.8%) were reoperated on because of perioperative complications. Overall morbidity for patients undergoing laparoscopic cholecystectomy was 3.5%. Major complications (0.6%) included a single common hepatic duct injury and a delayed cystic duct leak at 10 days. Minor complications occurred in 11 patients (2.9%). The single perioperative death (0.3%) was due to a myocardial infarction on postoperative day 3, after an otherwise uncomplicated laparoscopic procedure. Laparoscopic cholecystectomy appears to offer significant advantages to patient recovery, and these data suggest that it can be performed with an efficacy, morbidity rate, and mortality rate similar to those of open cholecystectomy.
1989年9月至1991年1月，连续375例患者接受了腹腔镜胆囊切除术。其中341例（91%）为择期手术，其余34例（9%）因急性胆囊炎（24例）、胆石性胰腺炎（9例）和胆管炎（1例）入院。375例患者中，20例中转开腹胆囊切除术，腹腔镜胆囊切除术患者的总体成功率为95%。319例患者（90%）在术后24小时内出院。141例患者完成了术中胆管造影，5例显示胆总管结石（4例通过术后内镜逆行胰胆管造影术[ERCP]处理，1例通过胆总管探查术[CBDE]处理）。在未进行胆管造影的214例患者中发现2例残留结石（0.9%）。3例患者（0.8%）因围手术期并发症再次手术。腹腔镜胆囊切除术患者的总体发病率为3.5%。主要并发症（0.6%）包括1例肝总管损伤和1例术后10天出现的延迟性胆囊管渗漏。11例患者（2.9%）出现轻微并发症。唯一的围手术期死亡（0.3%）是在术后第3天因心肌梗死导致的，此前腹腔镜手术未出现其他并发症。腹腔镜胆囊切除术似乎对患者恢复具有显著优势，这些数据表明其疗效、发病率和死亡率与开腹胆囊切除术相似。
