Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D
Department of Surgery, University Hospital, Uppsala, Sweden.
Br J Surg. 1994 Sep;81(9):1362-5. doi: 10.1002/bjs.1800810936.
Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis. There is very little evidence, however, to support the claimed benefit to patients. In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were randomized to laparoscopic or conventional open cholecystectomy. Median (interquartile range) intravenous consumption of pethidine with a patient-controlled injection device between 13 and 24 h after surgery was 125 (62-175) mg in patients who underwent the laparoscopic procedure and 200 (150-250) mg in those who had open operation. Urinary adrenaline and cortisol levels as well as those of plasma glucose, C-reactive protein and interleukin 6 were increased after surgery in both groups of patients, but without any significant difference between them. The mean(s.d.) duration of postoperative hospital stay (2.8(0.8) versus 1.8(0.6) days) and sick leave (24.0(4.4) versus 11.7(4.1) days) was significantly longer with open than laparoscopic cholecystectomy. The findings demonstrate obvious advantages of laparoscopic surgery as regards postoperative pain and convalescence, although factors reflecting the magnitude of trauma did not differ.
腹腔镜胆囊切除术已迅速成为胆囊结石的首选治疗方法。然而，几乎没有证据支持其对患者声称的益处。在本研究中，30例年龄在65岁以下、无急性胆囊炎且无胆总管结石迹象的连续患者被随机分为腹腔镜胆囊切除术组或传统开腹胆囊切除术组。接受腹腔镜手术的患者术后13至24小时使用患者自控注射装置静脉注射哌替啶的中位数（四分位间距）为125（62 - 175）mg，接受开腹手术的患者为200（150 - 250）mg。两组患者术后尿肾上腺素、皮质醇水平以及血糖、C反应蛋白和白细胞介素6水平均升高，但两组之间无显著差异。开腹胆囊切除术的术后平均住院时间（2.8（0.8）天对1.8（0.6）天）和病假时间（24.0（4.4）天对11.7（4.1）天）明显长于腹腔镜胆囊切除术。研究结果表明，尽管反映创伤程度的因素没有差异，但腹腔镜手术在术后疼痛和康复方面具有明显优势。
