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日间腹腔镜胆囊切除术在胆囊疾病治疗中的应用:文献综述。

Day-case laparoscopic cholecystectomy in the management of gallbladder disease: a literature review.

机构信息

Department of General Surgery, Wirral University Teaching Hospitals, Birkenhead, UK.

General Surgery Department, Wirral University Teaching Hospital NHS Trust, Wirral, UK.

出版信息

Langenbecks Arch Surg. 2024 Sep 28;409(1):292. doi: 10.1007/s00423-024-03479-6.

Abstract

BACKGROUND

Day-case laparoscopic cholecystectomy (DCLC) has gained traction globally due to its benefits, including shorter hospital stays, reduced costs, and enhanced patient experience. While concerns about patient safety, particularly related to bleeding and bile duct injury persist, the literature supports the efficacy and advantages of DCLC highlighting the need for its wider adoption in healthcare settings to optimise resources and improve patient outcomes.

METHODS

This was a literature review that aims to assess the feasibility and safety of day-case laparoscopic cholecystectomy for symptomatic gallstone patients, focusing on incidence and aetiology of unexpected admissions and readmissions, as well as conversion-to-open rates. PubMed was searched for all studies focusing on DCLC between 2014 and 2024. The timeframe was specifically selected to identify recent trends and practices in this evolving field. By focusing on this specific period, the review aims to provide a comprehensive analysis of current practices, emerging trends, and the evolving standard of care in this area.

RESULTS

This review highlights that the main causes of unexpected admission post DCLC were postoperative nausea, vomiting, and pain, while the implementation of anaesthetic pathways notably increased day-case rates. Studies addressing complication rates postoperatively consistently found no significant difference between day-case and in-patient procedures.

CONCLUSIONS

DCLC for symptomatic gallstone patients is supported by research as safe and effective, with high success rates and patient satisfaction. Studies show minimal complications and acceptable readmission rates, suggesting that DCLC can be the standard approach for selective patients, improving outcomes and healthcare efficiency.

摘要

背景

日间腹腔镜胆囊切除术(DCLC)因其优势在全球范围内得到了广泛应用,包括缩短住院时间、降低成本和改善患者体验。尽管人们对患者安全仍存在担忧,特别是与出血和胆管损伤有关的问题,但文献支持 DCLC 的疗效和优势,强调需要在医疗保健环境中更广泛地采用它,以优化资源并改善患者的结果。

方法

这是一项文献综述,旨在评估日间腹腔镜胆囊切除术治疗有症状的胆囊结石患者的可行性和安全性,重点关注意外住院和再入院的发生率和病因,以及转为开放手术的比例。通过在 PubMed 上搜索 2014 年至 2024 年期间所有关于 DCLC 的研究,来评估日间腹腔镜胆囊切除术治疗有症状的胆囊结石患者的可行性和安全性。选择这一特定时间段是为了识别该领域不断发展的最新趋势和实践。通过关注这一特定时期,该综述旨在提供对该领域当前实践、新兴趋势和不断发展的护理标准的全面分析。

结果

本综述强调,DCLC 后意外住院的主要原因是术后恶心、呕吐和疼痛,而麻醉途径的实施显著提高了日间手术率。研究报告术后并发症发生率的研究发现,日间手术和住院手术之间没有显著差异。

结论

有症状的胆囊结石患者行 DCLC 是安全有效的,成功率高,患者满意度高。研究表明并发症发生率低,可接受的再入院率,表明 DCLC 可以成为选择性患者的标准治疗方法,改善结果和医疗保健效率。

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