Hölbling N, Pilz E, Feil W, Schiessel R
Chirurgische Abteilung, Donauspital, Wien.
Wien Klin Wochenschr. 1995;107(5):158-62.
Meta-analysis of 23,700 laparoscopic cholecystectomies of 27 authors shows an intraoperative complication rate of 1.35% and a postoperative complication rate of 3%, including injuries of the bile duct in 0.48% and of the intestine in 0.19%. A second operation was necessary in 1.26%. In 0.43% retained common bile duct stones were observed. The conversion rate was 4.1% and the mortality rate was 0.08%. Our own experience in laparoscopic cholecystectomy as a standard procedure on 455 out of 574 unselected patients (50 acute, 405 elective) resulted in 9 (2.2%) intraoperative and 5 (1.2%) postoperative complications. In 4 cases (0.9%) the complications necessitated a second operation. The conversion rate was 11.6% and the mortality rate was zero. It is concluded that the results of laparoscopic cholecystectomy appear equivalent the "gold standard" of open cholecystectomy up to certain pathomorphological limits. Using an exact preoperative diagnostic regimen (sonography, cholangiography, ERCP if indicated) the place of routine intraoperative cholaniography is discussed critically.
对27位作者的23700例腹腔镜胆囊切除术进行的荟萃分析显示，术中并发症发生率为1.35%，术后并发症发生率为3%，包括0.48%的胆管损伤和0.19%的肠道损伤。1.26%的患者需要进行二次手术。0.43%的患者观察到胆总管结石残留。中转率为4.1%，死亡率为0.08%。我们自己对574例未经选择的患者（50例急性，405例择期）中的455例进行腹腔镜胆囊切除术作为标准手术的经验显示，有9例（2.2%）术中并发症和5例（1.2%）术后并发症。4例（0.9%）并发症需要进行二次手术。中转率为11.6%，死亡率为零。结论是，在某些病理形态学限度内，腹腔镜胆囊切除术的结果似乎与开腹胆囊切除术的“金标准”相当。使用精确的术前诊断方案（超声、胆管造影、必要时行内镜逆行胰胆管造影），对常规术中胆管造影的地位进行了批判性讨论。
