Smith M, Wheeler W, Ulmer M B
Spartanburg Regional Medical Center, SC, USA.
JSLS. 1997 Jan-Mar;1(1):51-3.
The development of laparoscopic cholecystectomy has allowed the introduction of outpatient surgery for biliary tract disease. However, there appears to be a wide variation of the interpretation of "outpatient surgery," ranging from discharge the same day to keeping patients for overnight observation. We prospectively reviewed the last 50 chole-cystectomies performed at Spartanburg Regional Medical Center, a private teaching institution, and Upstate Carolina Medical Center, a private nonteaching hospital. All cholecystectomies were performed by board certified surgeons or surgical residents under the supervision of board certified surgeons. Spartanburg Regional Medical Center's standard was 23-hour observation with 9 patients (18%) being discharged home the day of surgery. Upstate Carolina Medical Center's standard was discharge home (usually 4-8 hours after completion of the procedure) with 39 patients (78%) discharged the same day. No patient discharged the same day presented back with any significant complication. Comorbid disease, biliary pancreatitis, ascending cholangitis, gangrenous gallbladder, extreme age and living conditions and conversion to open were factors considered for admission. Intra-operative difficulty such as oozing, excessive adhesiolysis, postoperative nausea, vomiting or pain control were also indications for overnight admissions. The extra 15 to 19 hours for routine observation did not change any treatment for any of the 41 patients and resulted in additional cost to the hospital of approximately $15,000. We conclude that same day, outpatient laparoscopic cholecystectomy can be done safely with discharge home 4 to 8 hours postoperative without significant morbidity in selective patients.
腹腔镜胆囊切除术的发展使得胆道疾病的门诊手术得以开展。然而，对于“门诊手术”的定义似乎存在很大差异，从当日出院到留院过夜观察不等。我们前瞻性地回顾了在斯帕坦堡地区医疗中心（一家私立教学机构）和南卡罗来纳州北部医疗中心（一家私立非教学医院）进行的最后50例胆囊切除术。所有胆囊切除术均由获得委员会认证的外科医生或外科住院医师在获得委员会认证的外科医生监督下进行。斯帕坦堡地区医疗中心的标准是观察23小时，9名患者（18%）在手术当天出院回家。南卡罗来纳州北部医疗中心的标准是出院回家（通常在手术完成后4至8小时），39名患者（78%）在同一天出院。没有当日出院的患者出现任何严重并发症。入院时考虑的因素包括合并症、胆源性胰腺炎、化脓性胆管炎、坏疽性胆囊炎、高龄、生活条件以及转为开腹手术。术中困难如渗血、过度粘连松解、术后恶心、呕吐或疼痛控制也是留院过夜观察的指征。对41名患者中的任何一人来说，额外的15至19小时常规观察并没有改变任何治疗方案，却给医院带来了约15,000美元的额外费用。我们得出结论，对于部分患者，术后4至8小时出院的当日门诊腹腔镜胆囊切除术可以安全进行，且不会出现明显的发病率。
