Kurauchi N, Kamii N, Kazui K, Saji Y, Uchino J
First Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Surg Today. 1998;28(7):714-8. doi: 10.1007/BF02484617.
We analyzed the outcome of 1408 patients who underwent laparoscopic cholecystectomy (LC) between February 1991 and October 1993 in affiliated community hospitals around Hokkaido, Japan. LC was performed for symptomatic gallstones (68%) and asymptomatic gallstones (29%) using the pneumoperitoneum (96%) or abdominal wall lift (4%) techniques. Intraoperative and postoperative complications occurred in 105 patients (10%), including bile duct injuries in 9 patients (0.9%). Conversion to open surgery or reoperation was required in 89 patients (8%) mainly because of unclear anatomy, difficulties with hemostasis, or bile duct injury. One patient died of congestive heart failure, resulting in a mortality rate of 0.07%. The patients were discharged after an average of 8 days, and returned to work after an average of 14 days. The complication and conversion rates were high; however, the incidences of reoperation, bile duct injuries, postoperative bile leaks, and deaths were low. In conclusion, LC was performed with acceptable safety in our community hospitals. The reason for this is most likely that conventional cholecystectomy was preferred to LC in difficult cases during this early period.
我们分析了1991年2月至1993年10月期间在日本北海道周边附属医院接受腹腔镜胆囊切除术（LC）的1408例患者的手术结果。LC用于治疗有症状胆结石（68%）和无症状胆结石（29%），采用气腹法（96%）或腹壁提升法（4%）技术。105例患者（10%）发生术中及术后并发症，其中9例（0.9%）发生胆管损伤。89例患者（8%）需要转为开放手术或再次手术，主要原因是解剖结构不清、止血困难或胆管损伤。1例患者死于充血性心力衰竭，死亡率为0.07%。患者平均8天后出院，平均14天后恢复工作。并发症和中转率较高；然而，再次手术、胆管损伤、术后胆漏和死亡的发生率较低。总之，在我们的社区医院，LC的安全性是可以接受的。最有可能的原因是，在这个早期阶段，在困难病例中，传统胆囊切除术比LC更受青睐。
