Zhu Jie-gao, Han Wei, Zhang Zhong-tao, Guo Wei, Liu Wei, Li Jianshe
1 Department of General Surgery, Beijing Friendship Hospital of Capital Medical University , Beijing, People's Republic of China .
J Laparoendosc Adv Surg Tech A. 2014 May;24(5):302-5. doi: 10.1089/lap.2013.0537. Epub 2014 Apr 18.
Reducing the length of stay and discharge time for patients could benefit multiple hospital units by saving money, reducing waiting time, and providing the opportunity for more patients to be treated. However, no experience of laparoscopic transcystic common bile duct exploration (LTCBDE) with discharge less than 24 hours has been reported until now. The objective of this study was to assess the feasibility and safety of LTCBDE with discharge less than 24 hours.
A retrospective review showed that 34 of 111 patients scheduled in our institution were discharged less than 24 hours after LTCBDE between June 1 and December 31, 2011. A multimodal approach including appropriate preoperative assessment, education and counseling, early postoperative oral intake, and early mobilization was carried out. Outcomes were analyzed for patient demographics, postoperative stay, operation time, intraoperative bleeding, and reasons for failed LTCBDE.
Of 111 patients admitted for LTCBDE, 34 patients were discharged within 24 hours postoperatively. This study population comprised 11 males and 23 females with a mean age of 54.6±14.7 years (range, 28-79 years). The mean postoperative stay was 20.21±0.39 hours. There were no postoperative complications or deaths during the hospital stay or at the follow-up 12 months postoperatively in these 34 patients.
LTCBDE with discharge less than 24 hours is feasible and safe in selected patients with common bile duct stones of no more than three in number and no more than 6 mm in size. The benefit of the multimodal approach and LTCBDE may be synergistic, allowing a quick recovery of gastrointestinal function.
缩短患者住院时间和出院时间可通过节省资金、减少等待时间以及为更多患者提供治疗机会而使多个医院科室受益。然而，迄今为止尚无腹腔镜经胆囊管胆总管探查术（LTCBDE）术后24小时内出院的相关报道。本研究的目的是评估术后24小时内出院的LTCBDE的可行性和安全性。
一项回顾性研究表明，2011年6月1日至12月31日期间，在我院计划接受手术的111例患者中，有34例在LTCBDE术后24小时内出院。采用了多模式方法，包括适当的术前评估、教育与咨询、术后早期经口进食以及早期活动。分析了患者人口统计学资料、术后住院时间、手术时间、术中出血情况以及LTCBDE失败的原因等结果。
111例接受LTCBDE的患者中，34例在术后24小时内出院。该研究人群包括11名男性和23名女性，平均年龄为54.6±14.7岁（范围28 - 79岁）。术后平均住院时间为20.21±0.39小时。这34例患者在住院期间及术后12个月随访时均未出现术后并发症或死亡。
对于数量不超过3个且大小不超过6毫米的胆总管结石患者，术后24小时内出院的LTCBDE是可行且安全的。多模式方法和LTCBDE的益处可能具有协同作用，可使胃肠功能快速恢复。
