Schirmer B D, Dix J, Schmieg R E, Aguilar M, Urch S
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Surg Endosc. 1995 Oct;9(10):1085-9. doi: 10.1007/BF00188992.
The first 1000 patients undergoing laparoscopic cholecystectomy (LC) at our institution were reviewed to investigate the impact of previous abdominal surgery on LC. The 454 patients having no previous abdominal surgery (NS) were compared to the 541 patients who had previous surgery (PS). PS patients were older, more likely to be female, and had a higher ASA risk category. PS patients had a higher incidence of wound infection, but in all other parameters of outcome, including operative duration and completion, length of hospitalization, and morbidity, there were no significant differences between PS and NS. When PS patients with previous upper abdominal surgery (PUAS, n = 59) were separately compared to the remainder of the entire patient group (NUAS, n = 936), the PUAS group was found to be older, to be more likely to be male, and to have a higher ASA risk category. PUAS patients had a longer postoperative hospitalization, and an increased incidence of intraoperative, postoperative, and total complications, readmissions to the hospital, and unrelated deaths. We conclude previous lower abdominal surgery has little impact on the outcome of patients undergoing LC while previous upper abdominal surgery is associated with increased morbidity.
对我院首批1000例行腹腔镜胆囊切除术（LC）的患者进行回顾性研究，以探讨既往腹部手术对LC的影响。将454例无既往腹部手术史（NS）的患者与541例有既往手术史（PS）的患者进行比较。PS组患者年龄更大，女性比例更高，ASA风险分级更高。PS组患者伤口感染发生率更高，但在包括手术时长及完成情况、住院时间和发病率等所有其他结局参数方面，PS组与NS组之间无显著差异。当将有既往上腹部手术史的PS组患者（PUAS，n = 59）与整个患者组的其余部分（无既往上腹部手术史，NUAS，n = 936）单独进行比较时，发现PUAS组患者年龄更大，男性比例更高，ASA风险分级更高。PUAS组患者术后住院时间更长且术中、术后及总并发症、再次入院和非相关性死亡的发生率增加。我们得出结论，既往下腹部手术对行LC患者的结局影响不大，而既往上腹部手术则与发病率增加相关。
