Chirurgia (Bucur). 2020 Nov-Dec;115(6):756-766. doi: 10.21614/chirurgia.115.6.756.
Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.
胆囊疾病是一种常见的问题，腹腔镜胆囊切除术（LC）是一种常见的择期手术。这项手术由普通外科医生、结直肠外科医生、乳腺和血管外科医生根据英国最大的审计（CholeS 研究）进行操作。目的：比较由专门的上消化道（UGI）外科医生进行腹腔镜胆囊切除术与 CholeS 和大型国际研究的结果。我们的假设是：UGI 专家为 LC 患者带来更好的结果。
所有在一家医院由 UGI 顾问在 1999 年至 2019 年期间进行的 LC 患者和在另一家医院由另一位 UGI 顾问外科医生在 2014 年至 2019 年期间进行的 LC 患者均被纳入研究。纳入标准为 UGI 外科医生进行的 LC。失访、由受训者进行的手术和胆囊癌患者被排除在外。报告的结果测量指标包括胆汁漏、胆管损伤、出血、感染并发症、肠损伤、血管损伤和假性动脉瘤、神经痛、端口疝、肠系膜血肿、30 天死亡率和转为开放性手术。使用统计检验来评估显著差异，置信区间为 95%，p 值为 0.05。两位 UGI 专家进行了 5122 例 LC，其中 4396 例（86%）为女性，715 例（14%）为男性。年龄为 13-93 岁（中位数为 48 岁）。3681 例（72%）为日间手术病例，1431 例（28%）为住院病例，287 例（5.6%）为急诊 LC。在手术 30 天期间无死亡，8 例（0.15%）从 Luschka 胆管漏出胆汁，4 例（0.19%）胆管（CBD）损伤，9 例（0.02%）转为开放性手术，17 例（0.33%）手术被放弃。我们的研究与 CholeS 报告在上述并发症方面存在显著差异。
当由专门的上消化道外科医生进行腹腔镜胆囊切除术时，其结果可接受，胆管损伤风险低，且无死亡率。
