Go P M, Dirksen C D
Department of surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Int Surg. 1995 Oct-Dec;80(4):304-6.
Since its introduction in spring 1990, laparoscopic cholecystectomy has become the treatment of choice for uncomplicated gallstone disease in The Netherlands. Several nation-wide surveys conducted by the authors show a rapid diffusion of this operation. 70-75% of all cholecystectomies are performed laparoscopically in almost all Dutch hospitals. The incidence of common bile duct lesions was relatively high at the beginning (1% in 1991) but declined to 0.68% at the end of 1992. It is assumed that the incidence of these lesions will decrease further to a percentage comparable to that after conventional cholecystectomies of 0.5%. The wound related complications of 1.65% is rather low. Despite the reduction in operative morbidity and early resumption of full activity resumption laparoscopic cholecystectomy has met financial restraints, because of the budget system in The Netherlands. There are no incentives for surgeons, hospital management and health insurance companies to stimulate laparoscopic cholecystectomy. The social-economic benefit of the operation is difficult to quantify in the current health care system in The Netherlands.
自1990年春季引入以来，腹腔镜胆囊切除术已成为荷兰单纯性胆结石疾病的首选治疗方法。作者进行的几项全国性调查显示，这种手术迅速普及。在几乎所有荷兰医院，70%-75%的胆囊切除术是通过腹腔镜进行的。胆总管损伤的发生率起初相对较高（1991年为1%），但到1992年底降至0.68%。据推测，这些损伤的发生率将进一步降至与传统胆囊切除术后相当的0.5%。伤口相关并发症发生率为1.65%，相当低。尽管手术发病率降低且能较早完全恢复活动，但由于荷兰的预算制度，腹腔镜胆囊切除术面临财政限制。对于外科医生、医院管理层和健康保险公司而言，不存在刺激开展腹腔镜胆囊切除术的激励措施。在荷兰当前的医疗保健系统中，该手术的社会经济效益难以量化。
