Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Hepatobiliary Pancreat Dis Int. 2010 Feb;9(1):60-4.
Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC.
Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented.
One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Follow-up showed that 90% of the patients were satisfied with the procedure. In the OPLC group, 99% of the patients underwent the procedure with a median operative time of 21.6 minutes and bleeding of 14.7 ml. The patients took liquid 11.3 hours then soft diet 20.1 hours after surgery. The mean postoperative hospital stay was 28.5 hours. In this group, 89% of the patients were discharged within the first 24 hours, and the remaining 11% were released within 48 hours after surgery. Two patients developed local complications. The cost for surgery and hospitalization was 7235.7 RMB yuan, which was 17.5% less than that in the IPLC group. At follow-up, 94% of the patients were satisfied with the surgery and short hospital stay.
OPLC can effectively treat a variety of benign, non-acute gallbladder diseases with shortened waiting time and postoperative hospital stay. OPLC benefits the hospital with a rapid bed turnover rate, and reduces cost for surgery and hospitalization.
门诊腹腔镜胆囊切除术（OPLC）最初在美国和其他发达国家开展，作为在日间手术中心进行的快速通道手术之一。然而，这种做法尚未在中国的大型综合医院和医疗中心常规实施。我们设计了这项病例对照研究，以评估 OPLC 的可行性、益处和安全性。
2007 年 4 月至 2008 年 12 月，在南京大学医学院金陵医院接受腹腔镜胆囊切除术治疗各种良性胆囊疾病的 200 例患者被分为两组：OPLC 组（100 例）和对照组（100 例），指定为住院腹腔镜胆囊切除术（IPLC）。收集年龄、性别、手术指征、美国麻醉医师协会（ASA）分级、手术时间、术中出血量、住院时间和围手术期并发症等数据。计算并分析手术和住院费用。腹腔镜胆囊切除术的手术程序和仪器均标准化，由两位专门从事腹腔镜手术的主治外科医生进行操作。OPLC 根据我院外科医生制定的标准标准进行选择。记录并记录从腹腔镜转为开腹胆囊切除术的原因。
100 例患者符合手术选择标准，99%完成手术。IPLC 的中位手术时间为 24.0 分钟，出血量为 16.2 毫升，恢复液体和软食的时间分别为 10.7 小时和 22.0 小时。仅 1 例患者术后发生尿路感染。IPLC 的平均住院时间为 58.2 小时，手术和住院费用平均为 8770.5 元人民币。随访显示，90%的患者对手术满意。在 OPLC 组中，99%的患者接受了手术，中位手术时间为 21.6 分钟，出血量为 14.7 毫升。患者术后 11.3 小时进液，20.1 小时进软食。平均术后住院时间为 28.5 小时。在该组中，89%的患者在 24 小时内出院，其余 11%的患者在手术后 48 小时内出院。2 例患者发生局部并发症。手术和住院费用为 7235.7 元人民币，比 IPLC 组减少 17.5%。随访时，94%的患者对手术和短住院时间满意。
OPLC 可有效治疗各种良性非急性胆囊疾病，缩短等待时间和术后住院时间。OPLC 使医院受益于快速床位周转率，并降低手术和住院费用。
