Taylor E, Gaw F, Kennedy C
Department of Surgery, Kern Medical Center, Bakersfield, California 93305, USA.
J Laparoendosc Surg. 1996 Apr;6(2):73-7. doi: 10.1089/lps.1996.6.73.
One-hundred nineteen elective cholecystectomies were performed at Kern Medical Center over a 20-month period from October 1992 to May 1994 and were retrospectively reviewed. Eight males and 111 females ranged in age from 16 to 70. Laparoscopic cholecystectomy was attempted in 116 patients and converted to open in 8 (7%). Of the elective procedures, 108 (91%) were planned as outpatient procedures. Of the 108 planned outpatient procedures, 73 (68%) were successfully completed as outpatients. Of the 35 patients who required unplanned admission, 21 were discharged in less than 24 h. In total, 101 (87%) of the 116 elective cholecystectomies begun laparoscopically were discharged in less than 24 h. Subsequent to this data analysis, our institution is developing a 23.9 h "day hospital" for postanesthesia observation. With extended postoperative monitoring and observation, patients with short-term problems such as nausea, vomiting, pain, and even patients with medical conditions requiring close observation and control should be able to avoid admission. This retrospective study indicates that with development of a 23.9 h postanesthesia care unit, the majority of elective cholecystectomies can be attempted and completed laparoscopically on an outpatient basis.
1992年10月至1994年5月的20个月期间，克恩医疗中心共进行了119例择期胆囊切除术，并进行了回顾性研究。其中男性8例，女性111例，年龄在16岁至70岁之间。116例患者尝试进行腹腔镜胆囊切除术，8例（7%）中转开腹。在择期手术中，108例（91%）计划作为门诊手术。在108例计划门诊手术中，73例（68%）成功作为门诊患者完成手术。在35例需要非计划入院的患者中，21例在24小时内出院。总共116例开始腹腔镜手术的择期胆囊切除术中，101例（87%）在24小时内出院。在此次数据分析之后，我们机构正在设立一个23.9小时的“日间医院”用于麻醉后观察。通过延长术后监测和观察，有恶心、呕吐、疼痛等短期问题的患者，甚至有需要密切观察和控制的医疗状况的患者，应该能够避免入院。这项回顾性研究表明，随着23.9小时麻醉后护理单元的设立，大多数择期胆囊切除术可以在门诊基础上尝试并通过腹腔镜完成。
