Buanes T, Mjåland O
Surgical Department, Ullevaal Hospital, Oslo, Norway.
Surg Laparosc Endosc. 1996 Aug;6(4):266-72.
Laparoscopic cholecystectomy (n = 250) was compared with the open procedure (n = 250) in a prospective comparative study focusing on complications. Severity grade was classified according to the Toronto system. The frequency of severity grade 1 complications was equal after open and laparoscopic cholecystectomy (5.6%), but major complications (grade 2 and higher) were significantly more frequent in the open group (10.4 versus 3.6%). The only postoperative death occurred after open cholecystectomy. The conventional advantages of laparoscopic cholecystectomy were also verified: The need for postoperative analgesics was significantly reduced from 7 (range, 4-16) standard opiate doses in the open group to 3 (range, 0-7) in the laparoscopic group. Hospital stay was reduced from 6 (range, 4-31) days after open surgery to 2 (range, 1-7) days after laparoscopic surgery and sick leave from 28 (range, 18-48) to 10 (range, 2-21) days, respectively. The overall complication rate was significantly higher in the open group (16 versus 9%, p < 0.01). In our hands, laparoscopic cholecystectomy carries a lower risk of serious complications than the open procedure.
在一项聚焦并发症的前瞻性对照研究中，对250例行腹腔镜胆囊切除术的患者与250例行开腹手术的患者进行了比较。严重程度分级按照多伦多系统进行。1级并发症的发生率在开腹胆囊切除术和腹腔镜胆囊切除术后相同（5.6%），但严重并发症（2级及以上）在开腹组中明显更为常见（10.4% 对3.6%）。唯一的术后死亡发生在开腹胆囊切除术后。腹腔镜胆囊切除术的传统优势也得到了验证：术后镇痛药物的需求从开腹组的7（范围4 - 16）个标准阿片类药物剂量显著减少至腹腔镜组的3（范围0 - 7）个。住院时间从开腹手术后的6（范围4 - 31）天减少至腹腔镜手术后的2（范围1 - 7）天，病假分别从28（范围18 - 48）天减少至10（范围2 - 21）天。开腹组的总体并发症发生率显著更高（16% 对9%，p < 0.01）。在我们的研究中，腹腔镜胆囊切除术比开腹手术发生严重并发症的风险更低。
