Rutledge R, Fakhry S M, Baker C C, Meyer A A
Department of Surgery, University of North Carolina at Chapel Hill 27599-7210, USA.
J Am Coll Surg. 1996 Jul;183(1):31-45.
Laparoscopic cholecystectomy (LC) has had a major impact on the treatment of patients with biliary tract disease, but the magnitude and the details of its effects on biliary surgery remain incompletely described. The purpose of this study was to perform a statewide, population-based, time-series analysis of the effects of LC on biliary surgery.
Patient data were obtained from the statewide hospital discharge database that collects data from all 157 hospitals in the state of North Carolina. All patients with hospital admissions for biliary tract disease from 1988 through 1993 were selected for analysis.
The use of open cholecystectomy (OC) dropped from 100 percent of all cholecystectomies in 1988 to 32.3 percent in 1993, while LC increased from eight cases in 1988 to over 7,800 per year in 1993. The increase in the rate of LC was not associated with an increase in the overall rate of cholecystectomy. Bile duct (BD) repairs increased from 13 in 1988 to a high of 36 in 1992. There was a strong, statistically significant correlation between the rate of LCs and the rate of BD repairs (R = 0.89, p = 0.0001). Hospital charges and component charges were lower for patients having elective LC compared to those having elective OC (p = 0.001). This remained true after stratification by age and type of gallbladder disease. Hospital stays were shorter for patients having LC than for those having OC (p = 0.001 for all). Surgeons in smaller hospitals were slower at adopting LC. Younger and board certified surgeons adopted LC more rapidly than older and non-board certified surgeons.
In North Carolina, LCs progressed from nonexistent to the dominant approach for managing patients with cholelithiasis in a matter of a few years. Associated with this change were shorter hospitalizations and lower charges. Contrary to other published reports, North Carolina did not experience an increase in the overall rate of cholecystectomy with the adoption of LC. There was a highly correlated increase in the rate of bile duct repairs in the first years of the study.
腹腔镜胆囊切除术（LC）对胆道疾病患者的治疗产生了重大影响，但其对胆道手术影响的程度和细节仍未得到充分描述。本研究的目的是对LC对胆道手术的影响进行一项全州范围的、基于人群的时间序列分析。
患者数据来自全州医院出院数据库，该数据库收集了北卡罗来纳州所有157家医院的数据。选取了1988年至1993年期间因胆道疾病入院的所有患者进行分析。
开腹胆囊切除术（OC）的使用比例从1988年所有胆囊切除术的100%降至1993年的32.3%，而LC则从1988年的8例增加到1993年的每年超过7800例。LC使用率的增加与胆囊切除术的总体率增加无关。胆管（BD）修复从1988年的13例增加到1992年的最高36例。LC率与BD修复率之间存在强的、统计学上显著的相关性（R = 0.89，p = 0.0001）。与接受择期OC的患者相比，接受择期LC的患者的医院收费和分项收费更低（p = 0.001）。按年龄和胆囊疾病类型分层后情况依然如此。接受LC的患者的住院时间比接受OC的患者短（所有情况p = 0.001）。较小医院的外科医生采用LC的速度较慢。年轻且获得委员会认证的外科医生比年长且未获得委员会认证的外科医生更快地采用LC。
在北卡罗来纳州，LC在短短几年内从不存在发展成为治疗胆石症患者的主要方法。与此变化相关的是住院时间缩短和费用降低。与其他已发表的报告相反，北卡罗来纳州采用LC后胆囊切除术的总体率并未增加。在研究的最初几年，胆管修复率有高度相关的增加。
