Oskarsson K, Oddsdottir M, Magnusson J
Laeknabladid. 1998 Jun;84(6):461-5.
Since the first laparoscopic cholecystectomy done at the Department of Surgery in November 1991, our aim has been to operate on all presenting patients by this method.
From November 17th 1991 until September 30th 1994, 384 cholecystectomies were performed. Open cholecystectomy was performed in 31 patients. The most frequent causes for open operation were; suspected stones in the choledochus, acute cholecystitis or biliary sepsis. The objective of this study was to determine the frequency of procedure-related complications and the frequency of conversion to open surgery. Furthermore, the operation time, the length of post-operative hospital stay, mortality and morbidity were studied.
A retrospective analysis of patients undergoing cholecystectomy during this period was performed. Post-operatively patients were also contacted by telephone. There were 121 males and 263 females, ranging between three and 91 year of age. Mean age was 53.2 years. Urgent operations (operation performed after emergency admission) were 43.9%, being highest in the last period of the study. Conversion to open surgery was needed in 63 cases (17.8%). The reasons were; adhesions (39.7%), unclear anatomy (17%) and bleeding (15.9%). Conversion rate was 13% for elective operations but 24% for acute cases. Reoperation was needed in 11 cases (3.8%). Seven patients were reoperated during the same hospital admission but four later on. The reasons were; bleeding (four), bile leakage (three), common duct stone (two), subphrenic abscess (one) and injury to the common bile duct (one). One patient (83 years old male) died of pulmonary embolus after a converted operation. The mean operation time for laparoscopic cholecystectomy was 94.9 minutes (30-210 minutes). For the first 100 operations the mean operative time was 99.3 minutes but 85.5 minutes for the last 100. The mean hospital stay after laparoscopic cholecystectomy was 3.1 days (ranging from just few hours to 60 days). Data on 257 patients after laparoscopic cholecystectomy showed that the mean loss of work or preoperative activity level was 17.6 days (2-87 days). There was a statistically significant difference between preoperative activity level in the emergency versus the elective group (21.4 or 15 days, p<0.05).
We conclude that laparoscopic cholecystectomy is a safe procedure and its safety will increase as surgeons gain more experience. Furthermore, this technique may be recommended for elective and emergency cases. Shorter hospital stay and fewer working days lost, followed by decreased expenses both for the patient as well as the community as a whole, must also be considered as a major advantage.
自1991年11月在外科开展首例腹腔镜胆囊切除术以来，我们的目标一直是采用这种方法为所有前来就诊的患者进行手术。
1991年11月17日至1994年9月30日期间，共进行了384例胆囊切除术。31例患者接受了开腹胆囊切除术。开腹手术最常见的原因是；怀疑胆总管结石、急性胆囊炎或胆源性败血症。本研究的目的是确定与手术相关的并发症发生率以及转为开腹手术的发生率。此外，还研究了手术时间、术后住院时间、死亡率和发病率。
对这一时期接受胆囊切除术的患者进行了回顾性分析。术后还通过电话联系了患者。患者中男性121例，女性263例，年龄在3岁至91岁之间。平均年龄为53.2岁。急诊手术（急诊入院后进行的手术）占43.9%，在研究的最后阶段最高。63例（17.8%）需要转为开腹手术。原因是；粘连（39.7%）、解剖结构不清（17%）和出血（15.9%）。择期手术的转化率为13%，但急性病例为24%。11例（3.8%）需要再次手术。7例患者在同一次住院期间再次手术，但4例在之后。原因是；出血（4例）、胆漏（3例）、胆总管结石（2例）、膈下脓肿（1例）和胆总管损伤（1例）。1例患者（83岁男性）在转为开腹手术后死于肺栓塞。腹腔镜胆囊切除术的平均手术时间为94.9分钟（30 - 210分钟）。前100例手术的平均手术时间为99.3分钟，但后100例为85.5分钟。腹腔镜胆囊切除术后的平均住院时间为3.1天（从数小时至60天不等）。257例腹腔镜胆囊切除术后患者的数据显示，工作或术前活动水平的平均损失为17.6天（2 - 87天）。急诊组与择期组术前活动水平存在统计学显著差异（分别为21.4天或15天，p<0.05）。
我们得出结论，腹腔镜胆囊切除术是一种安全的手术，随着外科医生经验的增加，其安全性将提高。此外，该技术可推荐用于择期和急诊病例。住院时间缩短、工作日损失减少，随之患者以及整个社区的费用降低，这也必须被视为一个主要优势。
