DeMar M A, Gruenberg J C
Department of Surgery, Saginaw Cooperative Hospitals, Inc., Michigan, USA.
J Laparoendosc Surg. 1995 Apr;5(2):71-6. doi: 10.1089/lps.1995.5.71.
In this community hospital medical center, all patients undergoing laparoscopic cholecystectomy (LC) who had a subsequent emergency room visit or hospital admission were reviewed to define the incidence and presentation of complications after hospital discharge. This unselected population, which is isolated geographically, provides a useful approximation of mortality and morbidity after hospital discharge. Of 1231 patients, 800 (65%) had no subsequent hospitalization or emergency room visit within a 6-32-month follow-up, whereas 431 (35%) did. Fifty-six (4.6%) patients had surgical complications related to their LC. The most serious complications were myocardial infarction (n = 1, the only death), common duct stricture (n = 2), retained common duct stone (n = 2), cystic duct leak (n = 2), subhepatic fluid collection or abscess (n = 3), pancreatitis (n = 3), and pulmonary (n = 5). Abdominal pain was the most common presenting symptom (62%), and 72% (42/56) occurred within 14 days, whereas, only 4% (15/375) patients with nonsurgically related complications presented within 14 days. In this study, emergency room visits and hospitalizations after LC occurred more commonly (35%) than generally appreciated, were usually minor, and were not related to the operative procedure, but serious late surgical complications occasionally appeared weeks to months postoperatively.
在这家社区医院医疗中心，对所有接受腹腔镜胆囊切除术（LC）且随后到急诊室就诊或住院的患者进行了回顾，以确定出院后并发症的发生率和表现。这个地理位置相对独立的未经过筛选的人群，能有效近似出院后的死亡率和发病率。在1231例患者中，800例（65%）在6至32个月的随访期内没有后续住院或急诊室就诊，而431例（35%）有。56例（4.6%）患者出现了与LC相关的手术并发症。最严重的并发症是心肌梗死（n = 1，唯一的死亡病例）、胆总管狭窄（n = 2）、胆总管残留结石（n = 2）、胆囊管漏（n = 2）、肝下积液或脓肿（n = 3）、胰腺炎（n = 3）和肺部并发症（n = 5）。腹痛是最常见的症状（62%），72%（42/56）在14天内出现，而在非手术相关并发症患者中，只有4%（15/375）在14天内出现症状。在本研究中，LC后急诊室就诊和住院的情况比一般认为的更常见（35%），通常症状较轻，且与手术操作无关，但严重的晚期手术并发症偶尔会在术后数周至数月出现。
