Afuwape O O, Akute O O, Adebanjo A T
Department of Surgery, University College Hospital, Ibadan, Nigeria.
West Afr J Med. 2012 Apr-Jun;31(2):120-3.
Presently many centers have facilities for laparoscopic surgery in Nigeria, but the practice is just evolving in most of these centers. This article presents the preliminary experience of the endoscopic surgery unit (general surgery) at the University College Hospital Ibadan Nigeria. The University College Hospital is the premier Nigerian teaching hospital and is located in the south-western part of the country.
All the patients who had laparoscopic cholecystectomy at the University College Hospital between June 2009 and January 2011 were included in this study. The patients' demographic data, diagnosis, results of investigations and intra-operative findings were obtained from the records. Additional information extracted from the records was the duration of surgery, complications, outcome and discharge periods.
There were thirteen patients over the twenty month period consisting of twelve females and one male. The age range was twenty six to sixty seven years with a mean of 44.6 years. The duration of surgery ranged from 90 to 189 minutes with a mean of 124 minutes. There were two complications. These were adhesive bowel obstruction and common bile duct injury. The duration of admission ranged from four to thirty two days with a mean of 7.53SD ± 8.5 days. There was one conversion to open surgery due to intra-operative gallbladder perforation with consequent dispersal of multiple gall stones within the peritoneal cavity. The common bile duct injury was diagnosed four days following surgery for which a choledochojejunostomy was done after initial conservative treatment. There was no mortality.
Laparoscopic surgery is feasible in Nigeria and is likely to show increasing popularity among patients and surgeons. A careful patient selection protocol is necessary for an acceptable success rate with minimal complications. Our protocol of patient selection eliminated the need for intra-operative common bile duct exploration which requires expensive instruments. However, to sustain laparoscopic surgery it is pertinent to ensure an activity based costing system which will not make it arbitrarily too expensive for the general population.
目前在尼日利亚，许多中心都具备开展腹腔镜手术的设施，但在大多数这些中心，该手术的开展仍处于发展阶段。本文介绍了尼日利亚伊巴丹大学学院医院内镜手术科室（普通外科）的初步经验。伊巴丹大学学院医院是尼日利亚的首要教学医院，位于该国西南部。
本研究纳入了2009年6月至2011年1月期间在伊巴丹大学学院医院接受腹腔镜胆囊切除术的所有患者。患者的人口统计学数据、诊断、检查结果及术中发现均从病历中获取。从病历中提取的其他信息包括手术时长、并发症、结局及出院时间。
在这20个月期间共有13例患者，其中12例女性，1例男性。年龄范围为26至67岁，平均年龄44.6岁。手术时长从90分钟至189分钟不等，平均时长为124分钟。出现了2例并发症，分别为粘连性肠梗阻和胆总管损伤。住院时长从4天至32天不等，平均时长为7.53标准差±8.5天。因术中胆囊穿孔导致多个胆结石散布于腹腔，有1例转为开腹手术。胆总管损伤在术后4天被诊断出来，在初始保守治疗后进行了胆总管空肠吻合术。无死亡病例。
腹腔镜手术在尼日利亚是可行的，并且可能会在患者和外科医生中越来越受欢迎。为了获得可接受的成功率并将并发症降至最低，需要一个谨慎的患者选择方案。我们的患者选择方案无需术中进行胆总管探查，而这需要昂贵的器械。然而，为了维持腹腔镜手术的开展，确保基于活动的成本核算系统是很有必要的，这样不会使其对普通大众来说过于昂贵。
