Zucker K A, Flowers J L, Bailey R W, Graham S M, Buell J, Imbembo A L
Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Am J Surg. 1993 Apr;165(4):508-14. doi: 10.1016/s0002-9610(05)80951-1.
The role of laparoscopic surgery in patients presenting with acute cholecystitis remains controversial. From September 1989 through August 1992, a total of 720 patients underwent cholecystectomy. Ninety-six were unplanned admissions with a clinical diagnosis of acute cholecystitis. Laparoscopic surgery was attempted in 83 patients. Thirteen individuals were not offered laparoscopy because of the surgeon's inexperience. Twenty-two (27%) patients required the laparoscopic procedure converted to an open laparotomy. The mean postoperative hospital stay for patients undergoing laparoscopic cholecystectomy was 3.3 days versus 6.8 days for the laparotomy group. There was no mortality and no bile duct or major vascular injuries in either group. The overall operative morbidity rate was 16.9%. Laparoscopic cholecystectomy appears to be a safe and beneficial option in selected patients with acute cholecystitis. A low threshold for conversion to laparotomy appeared to be an important factor in maintaining a low incidence of operative complications. Several modifications to the technique of laparoscopic cholecystectomy have evolved over the 3-year study period and are described.
腹腔镜手术在急性胆囊炎患者中的作用仍存在争议。从1989年9月至1992年8月，共有720例患者接受了胆囊切除术。其中96例为临床诊断为急性胆囊炎的非计划入院患者。83例患者尝试进行了腹腔镜手术。13例患者因外科医生经验不足未接受腹腔镜检查。22例（27%）患者需要将腹腔镜手术转为开腹手术。接受腹腔镜胆囊切除术患者的术后平均住院时间为3.3天，而开腹手术组为6.8天。两组均无死亡病例，也无胆管或主要血管损伤。总体手术发病率为16.9%。腹腔镜胆囊切除术似乎是部分急性胆囊炎患者的一种安全且有益的选择。较低的中转开腹阈值似乎是维持低手术并发症发生率的一个重要因素。在为期3年的研究期间，对腹腔镜胆囊切除术技术进行了多项改进，并予以描述。
