在单一中心进行12年腹腔镜胆囊切除术的经验教训。

Ying Fan, Shuodong Wu, Hong Yu, Yang Su, Jing Kong, Yu Tian, Amos Siwo Ernest

Department of First Minimal Invasive Surgery and Bile Duct Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, China 110004.

Hepatogastroenterology. 2010 Mar-Apr;57(98):202-6.

BACKGROUND/AIMS: This study was conducted to determine the results obtained with laparoscopic cholecystectomy (LC) at the Department of the First Minimal Invasive Surgery and Bile Duct Surgery, Sheng Jing Hospital of China Medical University. The authors compared current six years results with those at the former six years of the experience and developing a guideline.

METHODOLOGY

Between May 1997 and May 2009, 2400 LCs were performed at the "Department of the First Minimal Invasive Surgery and Bile Duct Surgery, Sheng Jing Hospital of China Medical University"; 952 patients were operated on between May 1997 and May 2003, and 1,448 between Jun 2003 and May 2009. Data describing the peri-operative interventions, operative methods and maneuvers, complications and methods of preventing them was collected and analyzed.

RESULTS

Mean hospital stay was 3.75 days. Conversion to open surgery was required for 0.46% of cases (11 patients). The surgical complication rate was 0.66%, with the most frequent being bile duct complications (0.42%) and bleeding (0.08%). Two patients died (0.08%). When the results (1997-2003 vs. 2003-2009) were compared, the differences in the history of a previous operation (30 vs. 23.8%, p = 0.001), role of the resident in LC (4.4 vs. 28.2%, p < 0.001), number of LCs for chronic calculous cholecystitis (52.42 vs. 66.16%, p < 0.001), for acute calculous cholecystitis (13.76 vs. 6.5%, p < 0.001) and for gallbladder polyp (32.76 vs. 26.45%, p = 0.001) and mean hospital stay (4.65 vs. 2.85 days, p = 0.034) was observed. In the latter 1448 cases (60.3%), LC was done without the need for routine urinary catheter or gastric tube insertion.

CONCLUSIONS

These results should be interpreted with caution as this is a retrospective study with much uncontrolled bias. We can rely on our practice to accumulate and summarize our experience to formulate perioperative interventions, gradually develop routines management protocols and shorten the learning curve.

背景/目的：本研究旨在确定中国医科大学附属盛京医院第一微创外科及胆管外科行腹腔镜胆囊切除术（LC）的结果。作者将当前六年的结果与此前六年的经验进行比较，并制定一个指南。

方法

1997年5月至2009年5月期间，中国医科大学附属盛京医院第一微创外科及胆管外科共进行了2400例LC手术；1997年5月至2003年5月期间对952例患者进行了手术，2003年6月至2009年5月期间为1448例。收集并分析了描述围手术期干预措施、手术方法和操作、并发症及其预防方法的数据。

结果

平均住院时间为3.75天。0.46%的病例（11例患者）需要转为开腹手术。手术并发症发生率为0.66%，最常见的是胆管并发症（0.42%）和出血（0.08%）。2例患者死亡（0.08%）。比较结果（1997 - 2003年与2003 - 2009年）时，观察到既往手术史（30%对23.8%，p = 0.001）、住院医师在LC手术中的作用（4.4%对28.2%，p < 0.001）、慢性结石性胆囊炎的LC手术例数（52.42%对66.16%，p < 0.001）、急性结石性胆囊炎的LC手术例数（13.76%对6.5%，p < 0.001）、胆囊息肉的LC手术例数（32.76%对26.45%，p = 0.001）以及平均住院时间（4.65天对2.85天，p = 0.034）存在差异。在后面的1448例病例（60.3%）中，行LC手术时无需常规插入尿管或胃管。