Hall J C, Tarala R A, Hall J L
Department of General Surgery, Royal Perth Hospital, Western Australia.
J Laparoendosc Surg. 1996 Apr;6(2):87-92. doi: 10.1089/lps.1996.6.87.
Postoperative pulmonary complications (PPC) are common after upper abdominal surgery. The objective of this case-control study was to compare the incidence of PPC after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) within a tertiary care center. Patients were accrued from two sequential clinical trials that evaluated the role of incentive spirometry in the prevention of PPC after abdominal surgery. Included for study were patients with gallstones undergoing elective surgery who had an American Society of Anesthesiologists (ASA) classification < 3. All patients included in the study were encouraged to use an incentive spirometer at least 10 times each hour while awake. Patients with chronic bronchitis were excluded from study, as were patients who received other forms of physical therapy. OC was performed through either a transverse or an oblique incision. There was an equitable dispersion of putative risk factors for PPC between the groups at baseline. PPC were defined as clinical features consistent with collapse/consolidation, an otherwise unexplained temperature above 38 degrees C, plus either confirmatory chest radiology or positive sputum microbiology. The incidence of PPC was 2.7% (1/37) after LC and 17.2% (10/58) after OC (p < 0.05). It is concluded that PPC are less common after laparoscopic cholecystectomy than after open cholecystectomy.
术后肺部并发症（PPC）在上腹部手术后很常见。本病例对照研究的目的是比较在三级医疗中心内腹腔镜胆囊切除术（LC）和开腹胆囊切除术（OC）后PPC的发生率。患者来自两项评估激励肺活量测定法在腹部手术后预防PPC作用的连续临床试验。纳入研究的是接受择期手术的胆结石患者，其美国麻醉医师协会（ASA）分级<3。鼓励研究中纳入的所有患者在清醒时每小时至少使用激励肺活量计10次。排除患有慢性支气管炎的患者以及接受其他形式物理治疗的患者。OC通过横向或斜切口进行。两组在基线时PPC的假定危险因素分布均衡。PPC定义为与肺不张/实变一致的临床特征、体温高于38摄氏度且无其他合理解释，以及胸部放射学检查确诊或痰微生物学阳性。LC后PPC的发生率为2.7%（1/37），OC后为17.2%（10/58）（p<0.05）。结论是腹腔镜胆囊切除术后PPC比开腹胆囊切除术后少见。
