Chan A C, Chung S C, Lau J W, Brockwell J, Li M K, Tate J J, Au K T, Li A K
Prince of Wales Hospital, Hong Kong.
J R Coll Surg Edinb. 1994 Feb;39(1):26-30.
Prospective analysis of the first three hundred patients who underwent laparoscopic cholecystectomy was carried out in three surgical centres of Hong Kong. Over a 20-month period, 300 consecutive patients were recruited, including elective and emergency cases. The indications for laparoscopic cholecystectomy were symptomatic gallstones (78%), cholangitis (6%), pancreatitis (5%) and cholecystitis (11%). Patients with common duct stones (12) had preoperative endoscopic sphincterotomy and stone extraction prior to cholecystectomy. Laparoscopic cholecystectomy was accomplished successfully in 287 patients. Thirteen patients (4.3%) required conversion to open cholecystectomy. The reasons for conversion were: inability to identify cystic duct and common bile duct clearly (6); bleeding (5); Mirizzi syndrome (1); and slippage of cystic duct clip (1). The median operation time was 80 min with a range of 28-270 min. The median hospital stay was 3 days. Seventy-five per cent of patients required only a single dose of pethidine injection. None of the patients required blood transfusion. The overall complication rate was 7%. These included mild cellulitis of the subumbilical wound (3%) and postoperative chest infection (3%). One patient developed subphrenic abscess which resolved on percutaneous drainage under ultrasound guidance. Iatrogenic injury to the common bile duct was seen in one patient who had an impacted stone at Hartmann's pouch. With adequate training laparoscopic cholecystectomy can be performed safely. The advantages over open cholecystectomy are less wound pain, better cosmesis and shorter convalescence.
在香港的三个外科中心对首批300例行腹腔镜胆囊切除术的患者进行了前瞻性分析。在20个月的时间里，连续招募了300例患者，包括择期和急诊病例。腹腔镜胆囊切除术的适应证为有症状的胆结石（78%）、胆管炎（6%）、胰腺炎（5%）和胆囊炎（11%）。12例胆总管结石患者在胆囊切除术前先行内镜括约肌切开取石术。287例患者成功完成腹腔镜胆囊切除术。13例患者（4.3%）需要转为开腹胆囊切除术。转为开腹手术的原因有：无法清晰辨认胆囊管和胆总管（6例）；出血（5例）；Mirizzi综合征（1例）；胆囊管夹滑脱（1例）。中位手术时间为80分钟，范围为28 - 270分钟。中位住院时间为3天。75%的患者仅需单次注射哌替啶。无一例患者需要输血。总体并发症发生率为7%。这些并发症包括脐下伤口轻度蜂窝织炎（3%）和术后肺部感染（3%）。1例患者发生膈下脓肿，在超声引导下经皮引流后痊愈。1例在Hartmann袋处有嵌顿结石的患者发生了医源性胆总管损伤。经过充分培训，腹腔镜胆囊切除术可以安全实施。与开腹胆囊切除术相比，其优点是伤口疼痛较轻、美容效果更好、康复时间更短。
