Hanney R M, Bond G, de Costa A
Mount Druitt Hospital, New South Wales, Australia.
Aust N Z J Surg. 1997 Apr;67(4):166-7. doi: 10.1111/j.1445-2197.1997.tb01932.x.
All 534 laparoscopic cholecystectomies performed by five surgeons at a single institution over a 3-year period were reviewed as part of a quality assurance process. The aim of the review, which has previously been published in this journal, was to identify and quantify complications of the procedure. Five cases in this series were recognized where major intra-abdominal pathology not identified at the time of laparoscopic cholecystectomy required laparotomy shortly thereafter. These five cases are reported here because there has been little discussion in the literature of this problem associated with laparoscopic cholecystectomy.
The records of all 534 patients having a laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed and entered into a computer database (Microsoft Access). This data collection and recording have subsequently become an ongoing process of quality assurance.
Five of 534 patients treated by laparoscopic cholecystectomy failed to have resolution of their symptoms postoperatively. A laparotomy was subsequently required within 3-12 months which demonstrated causative pathology present, but not detected at, the time of laparoscopic cholecystectomy. Where possible, treatment of these laparotomy findings resolved the initial presenting symptoms of colicky epigastric pain.
The rate of 'missed diagnosis' is found to be < 1%. Laparoscopic cholecystectomy is a therapeutic, rather than diagnostic, procedure, and pre-operative discussion should include the possibility of further procedures being required subsequently, particularly when symptoms and signs are atypical.
作为质量保证流程的一部分，对一所机构的五名外科医生在3年时间内实施的534例腹腔镜胆囊切除术进行了回顾。该回顾的目的（此前已发表于本期刊）是识别并量化该手术的并发症。本系列中有5例在腹腔镜胆囊切除时未发现的腹腔内主要病变，随后不久需要进行剖腹手术。现将这5例报告于此，因为文献中很少有关于腹腔镜胆囊切除术相关这一问题的讨论。
回顾了1990年10月至1993年9月期间所有534例行腹腔镜胆囊切除术患者的记录，并录入计算机数据库（微软Access）。这种数据收集和记录随后成为质量保证的一个持续过程。
534例接受腹腔镜胆囊切除术的患者中有5例术后症状未缓解。随后在3 - 12个月内需要进行剖腹手术，术中发现了致病病变，但在腹腔镜胆囊切除时未检测到。尽可能对这些剖腹手术的发现进行治疗后，缓解了最初出现的上腹部绞痛症状。
发现“漏诊”率<1%。腹腔镜胆囊切除术是一种治疗性而非诊断性手术，术前讨论应包括随后可能需要进一步手术的可能性，尤其是当症状和体征不典型时。
