Watson D I, Mathew G, Williams J A
Royal Adelaide Centre for Endoscopic Surgery, Royal Adelaide Hospital, SA.
Med J Aust. 1995 Nov 20;163(10):527-30. doi: 10.5694/j.1326-5377.1995.tb124719.x.
To compare the clinical, training and cost implications of laparoscopic cholecystectomy with open cholecystectomy.
A university teaching hospital.
A retrospective review of all patients who underwent cholecystectomy in 1989, before the introduction of the laparoscopic technique, and in 1993, after the learning curve for laparoscopic cholecystectomy had been overcome.
Surgical indications, feasibility of laparoscopic approach, type of surgeon, operating time, hospital stay, postoperative complications, and cost analysis.
240 cholecystectomies were performed in 1989 and 293 in 1993. This is a 22% increase in overall workload and includes a significant increase (85%; P < 0.0001) in elective caseload. In 1993, 89% of patients underwent laparoscopic surgery, with conversion to open cholecystectomy in 6.8% of elective patients and 33% of emergency patients. Surgical indications remained the same, as did the time from diagnosis to cholecystectomy. There were significant changes in median length of hospital stay (from 10 days in 1989 to 4 days in 1993; P < 0.0001), successful intraoperative cholangiography (93% versus 73%; P < 0.0001), and exploration of the common bile duct (15% versus 5% of patients; P = 0.0005). The number of cholecystectomies performed by surgeons-in-training decreased from 65% to 40%, individual treatment costs were reduced by 62% and overall hospital costs were reduced by 53%. Complications fell from 12% to 7% (P = 0.07), with the only major bile duct injury occurring in 1989. There were three deaths in 1989 and two deaths in 1993. All deaths followed open surgery.
Laparoscopic cholecystectomy is associated with improved patient outcomes and, despite the increased workload, significant savings for hospitals.
比较腹腔镜胆囊切除术与开腹胆囊切除术在临床、培训及成本方面的影响。
一所大学教学医院。
对1989年（腹腔镜技术引入之前）和1993年（腹腔镜胆囊切除术学习曲线被克服之后）所有接受胆囊切除术的患者进行回顾性研究。
手术指征、腹腔镜手术的可行性、外科医生类型、手术时间、住院时间、术后并发症及成本分析。
1989年进行了240例胆囊切除术，1993年进行了293例。总体工作量增加了22%，其中择期病例数显著增加（85%；P<0.0001）。1993年，89%的患者接受了腹腔镜手术，择期手术患者中转开腹胆囊切除术的比例为6.8%，急诊患者为33%。手术指征及从诊断到胆囊切除的时间保持不变。中位住院时间有显著变化（从1989年的10天降至1993年的4天；P<0.0001），术中胆管造影成功率（93%对73%；P<0.0001），以及胆总管探查率（患者比例为15%对5%；P = 0.0005）。实习外科医生进行的胆囊切除例数从65%降至40%，个体治疗成本降低了62%，医院总成本降低了53%。并发症发生率从12%降至7%（P = 0.07），仅有的一例主要胆管损伤发生在1989年。1989年有3例死亡，1993年有2例死亡。所有死亡均发生在开腹手术后。
腹腔镜胆囊切除术可改善患者预后，且尽管工作量增加，但可为医院节省大量费用。
