Toydemir Toygar, Yerdel Mehmet Ali
Department of General Surgery, Istanbul Surgery Hospital, Istanbul, Turkey.
J Laparoendosc Adv Surg Tech A. 2010 Dec;20(10):831-7. doi: 10.1089/lap.2010.0226. Epub 2010 Oct 30.
The goal of this study is to prospectively evaluate the safety of concomitant cholecystectomy during laparoscopic anti-reflux surgery (LARS).
A total of 1000 patients underwent LARS between May 2004 and August 2009. Patients who had a LARS procedure alone were defined as group A and those who had cholecystectomy during the LARS were defined as group B. All data, including demographics, operative details, perioperative complications, and outcomes, were recorded to the prospective database. Chi-square and t-test were used for statistical analysis.
There were 934 (93.4%) patients in group A and 66 (6.6%) in group B. Cholelithiasis (n = 48) and gallbladder polyp larger than 10 mm (n = 18) were the indications for cholecystectomy. Demographic characteristics were similar among the groups. There were no mortality and conversion. The mean operating time was 50 minutes for group A and 80 minutes for group B (P = 0.0001). The mean hospital stay was 1 day for each group. The mean follow-up was 35 and 38 months for groups A and B, respectively (P = 0.195). Esophageal perforation, jejunal perforation, and pulmonary emboli were the major complications and were seen only in group A (P = 0.790). All other peroperative minor complications and postoperative dysphagia, bloating, and reflux recurrence were similar between the two groups (P > 0.05).
LARS and cholecystectomy can be performed safely during the same session without increasing the rates of morbidity and recurrence of reflux.
本研究的目的是前瞻性评估腹腔镜抗反流手术（LARS）同期行胆囊切除术的安全性。
2004年5月至2009年8月期间，共有1000例患者接受了LARS。单纯接受LARS手术的患者被定义为A组，在LARS期间接受胆囊切除术的患者被定义为B组。所有数据，包括人口统计学资料、手术细节、围手术期并发症和结局，均记录在前瞻性数据库中。采用卡方检验和t检验进行统计学分析。
A组有934例（93.4%）患者，B组有66例（6.6%）患者。胆囊结石（n = 48）和直径大于10 mm的胆囊息肉（n = 18）是胆囊切除术的指征。两组间人口统计学特征相似。无死亡病例和中转开腹病例。A组平均手术时间为50分钟，B组为80分钟（P = 0.0001）。两组平均住院时间均为1天。A组和B组的平均随访时间分别为35个月和38个月（P = 0.195）。食管穿孔、空肠穿孔和肺栓塞是主要并发症，仅在A组出现（P = 0.790）。两组间所有其他术中轻微并发症以及术后吞咽困难、腹胀和反流复发情况相似（P > 0.05）。
LARS和胆囊切除术可在同一次手术中安全进行，且不增加发病率和反流复发率。
