常规小切口腹腔镜胆囊切除术：200例患者的手术结果

Routine mini-laparoscopic cholecystectomy: Outcome in 200 patients.

作者信息

Dammaro C, Tranchart H, Gaillard M, Debelmas A, Ferretti S, Lainas P, Dagher I

机构信息

AP-HP, Antoine-Béclère Hospital, Department of Minimally Invasive Surgery, 92140 Clamart, France; Paris-Saclay University, 91405 Orsay, France.

出版信息

J Visc Surg. 2017 Apr;154(2):73-77. doi: 10.1016/j.jviscsurg.2016.08.001. Epub 2016 Sep 9.

DOI:10.1016/j.jviscsurg.2016.08.001

PMID:27618697

Abstract

INTRODUCTION

In order to improve the outcome of classical laparoscopic cholecystectomy (CLC), surgeons have attempted to minimize tissue trauma. The aim of this study is to describe the technique of mini-laparoscopic cholecystectomy (MLC) and to report the outcome of this approach when used as a routine procedure.

METHODS

Since January 2012, all consecutive patients undergoing MLC were included in this study. Operative and perioperative data were prospectively collected. Additionally, cost analysis was performed.

RESULTS

From 2012 to 2015, 200 MLC were performed (F/M: 132/68, mean age 45±16 years). Mean operative duration was 97±32min for the first 50 patients and 75±25min for the subsequent 150 patients (P<0.0001). Modifications in the number or size of trocars were necessary in nine of the first 50 procedures and in seven of the subsequent 150 procedures (P=0.003). Perioperative morbidity included gallbladder perforation (n=28) or moderate (<50mL) bleeding (n=6). Postoperative morbidity was 4%. The mean global cost for a MLC procedure was 1757±1855 euros. This cost decreased from 2946±3115 euros in the first 50 patients to 1390±1278 euros in the subsequent 150 patients (P=0.001).

CONCLUSION

Mini-laparoscopy can be used for routine elective cholecystectomy. This approach is associated with low morbidity and good cosmetic results.

摘要

引言

为了改善传统腹腔镜胆囊切除术（CLC）的疗效，外科医生一直致力于尽量减少组织创伤。本研究的目的是描述迷你腹腔镜胆囊切除术（MLC）的技术，并报告将该方法作为常规手术时的疗效。

方法

自2012年1月起，所有连续接受MLC的患者均纳入本研究。前瞻性收集手术及围手术期数据。此外，还进行了成本分析。

结果

2012年至2015年，共进行了200例MLC手术（男/女：132/68，平均年龄45±16岁）。前50例患者的平均手术时间为97±32分钟，后150例患者为75±25分钟（P<0.0001）。在前50例手术中有9例、后150例手术中有7例需要对套管针的数量或尺寸进行调整（P=0.003）。围手术期并发症包括胆囊穿孔（n=28）或中度（<50mL）出血（n=6）。术后并发症发生率为4%。MLC手术的平均总成本为1757±1855欧元。该成本从前50例患者的2946±3115欧元降至后150例患者的1390±1278欧元（P=0.001）。