Vetshev P S, Chilingaridi K E, Ippolitov L I, Safronov V V, Shpachenko F A, Prokhorova O V
Khirurgiia (Mosk). 1998(9):45-9.
The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.
本文描述了对102例胆总管结石合并结石性胆囊炎患者采用微创入路结合开放腹腔镜技术要素的胆囊切除术(MSE)的经验和技术。99例患者因慢性结石性胆囊炎接受手术,3例因急性结石性胆囊炎接受手术。患者年龄在23至76岁之间(平均年龄59.3±3.4岁)。进行MSE时切口的平均长度为4.1±0.3厘米。手术平均持续时间为42.4±5.3分钟。5例(4.9%)患者术中进行了胆管造影。研究表明,接受MSE的患者术后有可能避免使用麻醉性镇痛药。术后住院时间为3.8天。文中还考虑了胆石症患者不同手术治疗方式的社会和成本效益方面。对生活质量指数的研究使得得出以下结论成为可能:接受MSE的患者能更快恢复其日常社会和智力活动,传统治疗的负面因素(疼痛、消化不良、美容缺陷)几乎没有影响,他们对自身健康状况、幸福感的评价更高,这体现在手术患者更高的生活质量上。