Hegstad A C, Rørdam S, Bock G, Klafstad P C
Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
Tidsskr Nor Laegeforen. 1998 Apr 30;118(11):1686-90.
The appropriateness of a laparoscopic approach to cholecystectomy in community hospital settings has been questioned. To address this issue a prospective study of outcomes of laparoscopic cholecystectomies performed during a three year period at Telemark Community Hospital was undertaken. There were 229 procedures performed by five surgeons. 24 (10.5%) of the attempted laparoscopic cholecystectomies were converted to open cholecystectomies. The average hospital stay after laparoscopic cholecystectomy was 3.0 days (SD = 2.6). Minor intraoperative complications (gall bladder perforation, gall bladder bed bleeding) occurred in 43% of the laparoscopic procedures. There were nine cases (4.4%) of major intraoperative complications which included laceration of the common bile duct (n = 4, one discovered during surgery), ileal perforation (n = 1) and laceration of the liver (n = 4). The frequency of postoperative complications after laparoscopic cholecystectomy was 8.8%. Bile peritonitis was observed in three patients, of whom one died. There were no significant differences in intra- and postoperative complications between the surgeons performing the operations. The present results support the argument that laparoscopic cholecystectomies can be performed safely and effectively in community hospitals.
在社区医院环境中，腹腔镜胆囊切除术的适用性受到了质疑。为了解决这个问题，对泰勒马克社区医院三年期间进行的腹腔镜胆囊切除术的结果进行了一项前瞻性研究。由五位外科医生实施了229例手术。24例（10.5%）尝试的腹腔镜胆囊切除术转为开腹胆囊切除术。腹腔镜胆囊切除术后的平均住院时间为3.0天（标准差=2.6）。43%的腹腔镜手术出现了轻微术中并发症（胆囊穿孔、胆囊床出血）。有9例（4.4%）严重术中并发症，包括胆总管撕裂（n=4，1例在手术中发现）、回肠穿孔（n=1）和肝脏撕裂（n=4）。腹腔镜胆囊切除术后的术后并发症发生率为8.8%。三名患者出现胆汁性腹膜炎，其中一名死亡。实施手术的外科医生之间在术中和术后并发症方面没有显著差异。目前的结果支持了在社区医院可以安全有效地进行腹腔镜胆囊切除术这一观点。
