Widdison A L, Norton S, Armstrong C P
Department of Surgery, Frenchay Hospital, Bristol.
Ann R Coll Surg Engl. 1995 Jul;77(4):256-8.
We reviewed our experience with open cholecystectomy since laparoscopic cholecystectomy became the treatment of choice for symptomatic gallstones. Over a 3 year period 35 open (6%) and 578 laparoscopic cholecystectomies (94%) were performed. Fourteen trainee surgeons performed only 16 open cholecystectomies and assisted at 19. The proportion of open cholecystectomies declined through the study period. Ten emergency cholecystectomies were performed for empyema, gallbladder perforation, severe acute cholecystitis, liver abscess, and cholangitis. In 12 patients, laparoscopic surgery was converted to an open procedure because of severe inflammation, empyema, dense adhesions, carcinoma of the gallbladder, cholecystoduodenal fistula, and perforated small bowel. Ten patients underwent open cholecystectomy and bile duct exploration after failure to clear duct stones endoscopically, and three patients had Mirizzi's syndrome. Open cholecystectomy is infrequently performed giving trainee surgeons little experience. However, such cases are occasionally inevitable and laparoscopic surgeons need to have the appropriate skills.
自腹腔镜胆囊切除术成为有症状胆结石的首选治疗方法以来，我们回顾了我们开展开腹胆囊切除术的经验。在3年期间，共进行了35例开腹胆囊切除术（6%）和578例腹腔镜胆囊切除术（94%）。14名实习外科医生仅进行了16例开腹胆囊切除术，并协助进行了19例。在研究期间，开腹胆囊切除术的比例有所下降。因积脓、胆囊穿孔、严重急性胆囊炎、肝脓肿和胆管炎进行了10例急诊胆囊切除术。12例患者因严重炎症、积脓、致密粘连、胆囊癌、胆囊十二指肠瘘和小肠穿孔，腹腔镜手术转为开腹手术。10例患者在内镜下未能清除胆管结石后接受了开腹胆囊切除术和胆管探查，3例患者患有Mirizzi综合征。开腹胆囊切除术很少进行，实习外科医生几乎没有经验。然而，此类病例偶尔不可避免，腹腔镜外科医生需要具备适当的技能。
