Soper N J
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Am J Surg. 1993 Apr;165(4):522-6. doi: 10.1016/s0002-9610(05)80954-7.
Laparoscopic cholecystectomy may be performed safely in most patients with symptomatic cholelithiasis. There are few absolute contraindications to laparoscopic cholecystectomy. Many relative contraindications exist, which relate to the surgeon's experience and the ability of the operating team to manage potential complications. Preoperative evaluation should assess the potential nonbiliary problems that affect the performance of laparoscopic cholecystectomy, including severe cardiopulmonary disease, coagulopathy, cirrhosis, and pregnancy. Since most therapeutic laparoscopic procedures are currently performed with a carbon dioxide (CO2) pneumoperitoneum, the physiologic effects of the elevated abdominal pressure and absorbed CO2 must be understood by the surgeon. Specific nonbiliary problems addressed in this review are cardiopulmonary disease, hypercortisolism, cirrhosis and portal hypertension, morbid obesity, previous abdominal surgery, and pregnancy.
对于大多数有症状的胆结石患者，腹腔镜胆囊切除术可以安全地进行。腹腔镜胆囊切除术几乎没有绝对禁忌证。存在许多相对禁忌证，这与外科医生的经验以及手术团队处理潜在并发症的能力有关。术前评估应评估影响腹腔镜胆囊切除术实施的潜在非胆道问题，包括严重心肺疾病、凝血功能障碍、肝硬化和妊娠。由于目前大多数治疗性腹腔镜手术是在二氧化碳（CO2）气腹下进行的，外科医生必须了解腹压升高和CO2吸收的生理效应。本综述中涉及的特定非胆道问题有心肺疾病、皮质醇增多症、肝硬化和门静脉高压、病态肥胖、既往腹部手术史和妊娠。
