Berggren U, Arvidsson D, Haglund U
Department of Surgery, Uppsala University, University Hospital, Sweden.
Eur J Surg. 1998 Apr;164(4):287-95. doi: 10.1080/110241598750004526.
To study the diffusion of laparoscopic biliary surgery in Sweden, 1992-93.
A prospective survey of all biliary surgery for gallstone disease recorded for 8 weeks in 1992 and the same period in 1993.
All surgical departments in Sweden.
A consecutive series of 1938 patients in 1992 and 1748 patients in 1993.
The changing indications, diffusion, morbidity, mortality, postoperative and hospital stay after laparoscopic cholecystectomy (LC) in Sweden in 1992 compared with 1993.
Despite the spread of LC, the indications did not change between 1992 and 1993 (p=0.31). The total number of cholecystectomies decreased from 1938 in 1992 to 1748 in 1993. The overall percentage of laparoscopic cholecystectomies (LCs) increased from 74.7% to 81.2% (p <0.001) between 1992 and 1993. Postoperative morbidity and mortality after LC did not differ between 1992 and 1993, but the total morbidity was 9.0% in 1992 and 7.0% in 1993 (p=0.02). Mortality for all cholecystectomies did not change over the periods, being 0.6% in 1992 and 0.2% in 1993 (p=0.07). The numbers of LCs done in any hospital were divided in two groups, 20 or fewer and 21-80. In the smaller group, the postoperative morbidity was 7.1% and in the larger group it was 7.0%, (p=0.9). The postoperative mortality was 0.1% in both groups. The postoperative and total hospital stays of all cholecystectomies decreased from 3.4 days in 1992 to 2.9 days in 1993 (p=0.001) and from 5.0 in 1992 to 4.4 days in 1993 (p < 0.001), respectively. The postoperative and total hospital stays of LCs decreased from 2.0 in 1992 to 1.8 days in 1993 (p=0.009) and from 3.3 in 1992 to 2.9 days in 1993 (p=0.007), respectively.
Despite the introduction and diffusion of the new technology, LC, the indications for surgery did not change and the number of cholecystectomies did not increase from 1992 to 1993. The morbidity and mortality of LC and the mortality of all cholecystectomies were unchanged between 1992 and 1993, but the morbidity for all cholecystectomies decreased. The number of LC or all cholecystectomies done in any particular hospital were not related to morbidity or to mortality.
研究1992 - 1993年瑞典腹腔镜胆道手术的推广情况。
对1992年8周及1993年同期记录的所有胆结石病胆道手术进行前瞻性调查。
瑞典所有外科科室。
1992年连续纳入1938例患者，1993年连续纳入1748例患者。
1992年与1993年瑞典腹腔镜胆囊切除术（LC）术后的适应证变化、推广情况、发病率、死亡率、住院时间及总住院天数。
尽管LC得到推广，但1992年至1993年适应证未发生变化（p = 0.31）。胆囊切除术总数从1992年的1938例降至1993年的1748例。1992年至1993年，腹腔镜胆囊切除术（LCs）的总体比例从74.7%增至81.2%（p < 0.001）。1992年与1993年LC术后发病率和死亡率无差异，但1992年总发病率为9.0%，1993年为7.0%（p = 0.02）。各时期所有胆囊切除术的死亡率无变化，1992年为0.6%，1993年为0.2%（p = 0.07）。各医院实施的LC数量分为两组，20例及以下和21 - 80例。较小组术后发病率为7.1%，较大组为7.0%（p = 0.9）。两组术后死亡率均为0.1%。所有胆囊切除术的术后住院天数和总住院天数分别从1992年的3.4天降至1993年的2.9天（p = 0.001）和从1992年的5.0天降至1993年的4.4天（p < 0.001）。LC的术后住院天数和总住院天数分别从1992年的2.0天降至1993年的1.8天（p = 0.009）和从1992年的3.3天降至1993年的2.9天（p = 0.007）。
尽管新技术LC得以引入和推广，但1992年至1993年手术适应证未变，胆囊切除术数量未增加。1992年至1993年，LC的发病率和死亡率以及所有胆囊切除术的死亡率未变，但所有胆囊切除术的发病率有所下降。任何特定医院实施的LC或所有胆囊切除术数量与发病率或死亡率无关。
