Glättli A, Klaiber C, Metzger A
Universitätsklinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Schweiz Med Wochenschr. 1994 Mar 26;124(12):502-8.
Since its introduction a few years ago, laparoscopic cholecystectomy has become today the standard treatment of gallbladder stones. Compared to open surgery it involves little change in the preoperative investigations. There has been, especially in the beginning of the learning curve, a demand for preoperative visualization of the bile duct anatomy and for exclusion of intraductal stones. Thus the incidence of preoperative ERCP has risen with the development of laparoscopic cholecystectomy. For the advanced laparoscopic surgeon, the indications for laparoscopic cholecystectomy are the same as for open surgery. The benefits of laparoscopy for the patient are obvious and the results are favourable. Bile duct injury is a very severe complication and, at the beginning of the learning curve, the incidence has been somewhat higher than in open surgery. Therefore, proper training in laparoscopic surgery and quality control are necessary. Many reports on advanced laparoscopic procedures have already been published, but only the future will show the limits of this technique.
自从几年前引入以来,腹腔镜胆囊切除术如今已成为胆囊结石的标准治疗方法。与开放手术相比,它在术前检查方面变化不大。尤其是在学习曲线的初期,人们对术前胆管解剖结构的可视化以及排除胆管内结石有需求。因此,随着腹腔镜胆囊切除术的发展,术前内镜逆行胰胆管造影(ERCP)的发生率有所上升。对于经验丰富的腹腔镜外科医生来说,腹腔镜胆囊切除术的适应证与开放手术相同。腹腔镜手术对患者的益处显而易见,效果良好。胆管损伤是一种非常严重的并发症,在学习曲线的初期,其发生率比开放手术略高。因此,进行适当的腹腔镜手术培训和质量控制是必要的。关于先进腹腔镜手术的许多报告已经发表,但只有未来才能显示出这项技术的局限性。