腹腔镜胆囊切除术：白沙瓦莱迪·里德医院的经验

Khan Nadim, Naeem Mohammad, Bangash Adil, Sadiq Muzaffaruddin, Hamid Haris

Department of Surgery, Postgraduate Medical institute, Lady Reading Hospital, Peshawar, Pakistan.

J Ayub Med Coll Abbottabad. 2010 Apr-Jun;22(2):46-51.

BACKGROUND

Laparoscopic Cholecystectomy originally a minimal invasive surgical technique involving less hospital stay less economical burden decreased post op complication and early mobility. The objective was to analyse data of patients undergoing laparoscopic cholecystectomy at a surgical setup.

METHODS

This study was conducted at the Department of Surgery, Lady Reading Hospital, Peshawar from 11th January 2006 till 10th January 2009. Patients aged above 14 year, presenting in the outpatient department with clinical and ultrasonographic evidence of cholecystitis and undergoing laparoscopic cholecystectomy were included in the study. The procedure performed was predominantly the four port technique for laparoscopic cholecystectomy. A proforma was prepared to collect preoperative, operative, and postoperative data. Operative data included the technique used and the difficulties ascertained during those procedures. Data was analysed using SPSS-13.0.

RESULTS

Of 421 patients, 387 patients fulfilled the criteria for admission to undergo the procedure. The mean age of all patients was 38.6 +/- 7.1 year ranging from 16 years to 72 year with a male to female ratio of 1:8.09. During the first six months 57 patients underwent the procedure for which the mean operating time was 67.4 min. During the last six months the mean operating time was 39.1 +/- 8.9 minutes. The overall rate of conversion of laparoscopic cholecystectomy was 6.4%. In comparison the last six months of the study showed one case (1.16%) in 86 patients being converted to open cholecystectomy. The most common cause foe conversion of the laparoscopic procedure to an open cholecystectomy was dense adhesions making dissection of the triangle of Calot's difficult. In 73 cases (21.4%) the gall bladder was perforated during dissection of gall bladder from the gall bladder bed.

CONCLUSION

The out comes of this study during the last six months is comparable to studies conducted at more experienced centres making laparoscopic more than just an early experience in this part of the world.

背景

腹腔镜胆囊切除术最初是一种微创手术技术，具有住院时间短、经济负担轻、术后并发症减少和早期可活动等优点。目的是分析在一个手术机构接受腹腔镜胆囊切除术患者的数据。

方法

本研究于2006年1月11日至2009年1月10日在白沙瓦市雷丁夫人医院外科进行。年龄在14岁以上、在门诊部有胆囊炎临床及超声证据且接受腹腔镜胆囊切除术的患者纳入本研究。所采用的手术方法主要是腹腔镜胆囊切除术的四孔技术。准备了一份表格以收集术前、术中及术后数据。手术数据包括所使用的技术以及在这些手术过程中确定的困难。使用SPSS-13.0对数据进行分析。

结果

421例患者中，387例符合手术入院标准。所有患者的平均年龄为38.6±7.1岁，年龄范围为16岁至72岁，男女比例为1:8.09。在前六个月，57例患者接受了该手术，平均手术时间为67.4分钟。在最后六个月，平均手术时间为39.1±8.9分钟。腹腔镜胆囊切除术的总体中转率为6.4%。相比之下，研究的最后六个月中，86例患者中有1例（1.16%）转为开腹胆囊切除术。腹腔镜手术转为开腹胆囊切除术最常见的原因是粘连致密，使得胆囊三角区的解剖困难。在73例（21.4%）病例中，在从胆囊床分离胆囊时胆囊穿孔。