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1.
Background: The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholethiasis
remains a controversial subject. There have been few studies exploring the role of intraoperative ERCP. Therefore, we set
out to perform a retrospective review of 29 patients who underwent combined laparoscopic cholecystectomy (LC) and intreoperative
ERCP (LC/ERCP). Our objective was to assess the feasibility of a one-stage approach using intraoperative ERCP.
Methods: We identified 29 patients in whom LC/ERCP was attempted between January 1996 and November 1998 at a university-affiliated
hospital with a large private faculty. Parameters reviewed included preoperative diagnosis, liver function tests (LFT), finding
on transcystic cholangiogram (TCC), ERCP, stone retrieval, failure of ERCP, length of stay, morbidity, and mortality.
Results: Twenty-eight of 29 patients (97%) underwent successful combined LC/ERCP. Successful TCC followed by ERCP was performed in
21 of 26 patients (81%). Five TCC were technically unsuccessful; in these patients, ERCP was performed on the basis of preoperative
criteria. In three patients, TCC was not attempted. Stones were successfully retrieved from 20 of 21 patients (95%) with abnormal
finding on TCC, one of five patients (20%) with failed TCC, and two of three patients (67%) with ERCP but without TCC. Overall
morbidity was 14%, comprising two patients with postoperative hyperamylasemia and two with cystic duct leaks. There were no
deaths in the group. The mean time for the combined procedure was 173 min (range, 50–290). Mean length of hospitalization
was 3.4 days, and mean postoperative stay was 2.2 days.
Conclusions: LC/ERCP can be performed safely. The advantages of the combined procedures include one-stage treatment of cholelithiasis
and choledocholithiasis, avoidance of unnecessary preoperative ERCP and their concomitant complications, and elimination of
potential return to the operating room when postoperative ERCP is technically impossible.
Received: 3 February 1999/Accepted: 10 September 1999 相似文献
2.
Gallbladder cancer (GC) has been reported in 0.3–1.5% of cholecystectomies. Since the introduction of laparoscopic surgery,
cholecystectomies have increased and occult GC may therefore be more frequent. Herein we analyze our own experience to determine
whether there was an increase in GC. We also evaluate the risk factors for this outcome. Four patients with GC undiagnosed
before surgery (four of 602 cases, or 0.66%) were submitted to laparoscopic cholecystectomy. The percentage in patients who
underwent open surgery was 0.28% (two of 714 cases). Without reoperation, three patients died in the laparoscopic group and
one is alive at 12 months. Trocar site metastasis was not observed. Although the percentage of GC (0.28% versus 0.66%) increased,
the percentage is still in the referred average. Undiagnosed GC is on the increase. Examination of the gallbladder and a frozen
section, if necessary, are recommended. Calcified gallbladders, age >70 years, a long history of stones, and a thickened gallbladder
all represent significant risk factors.
Received: 30 July 1997/Accepted: 24 October 1997 相似文献
3.
Incisional hernias after laparoscopic vs open cholecystectomy 总被引:7,自引:1,他引:6
R. Sanz-López C. Martínez-Ramos J. R. Núñez-Peña M. Ruiz de Gopegui L. Pastor-Sirera S. Tamames-Escobar 《Surgical endoscopy》1999,13(9):922-924
Background: The aim of this study was retrospectively to compare the incidence of incisional hernia formation at trocar sites in laparoscopic
cholecystectomy with that after conventional open cholecystectomy.
Methods: In all, 271 patients with cholelithiasis underwent either laparoscopic cholecystectomy (LC group, n= 142) or open cholecystectomy (OC group, n= 129). In the OC group, the surgical approach was to use a right subcostal incision in 20.2%, right transrectal laparotomy
in 73.6%, and midlaparotomy in 6.2%. Laparotomy closure was performed by continuous absorbable suture for the peritoneum and
discontinuous absorbable stitches for muscle and fascia. Laparoscopic access was achieved by use of four trocars (two 10 mm
and two 5 mm). Umbilical port closure was performed by suture of fascia using discontinuous stitches. Closure of the remaining
ports was performed by suture of the skin.
Results: Both patient groups were statistically similar with respect to general risk factors. Follow-up was performed in 84 (65.1%)
OC and 123 (86.6%) LC patients and ranged from 2 to 10 years (mean, 8 years) and 1 to 5 years (mean, 3 years) respectively.
Five (5.9%) OC and two (1.6%) LC patients developed incisional hernias, although the difference between groups was not significant.
All hernias in OC patients appeared after transrectal laparotomy. The LC hernias appeared at the umbilical port, and one of
the patients developed an additional xiphoides port-associated hernia.
Conclusions: The laparoscopic technique showed a lower (although not significantly) incidence of incisional hernias than the open procedure.
Received: 16 July 1998/Accepted: 27 November 1998 相似文献
4.
Background: We evaluated the use of the ultrasonically activated (harmonic) scalpel (HS) in the performance of laparoscopic cholecystectomy
(LC).
Methods: A total of 282 consecutive patients, 64 of whom had acute cholecystitis at the time of surgery, underwent LC using HS dissection.
Indications for surgery included chronic pain (180 cases), episodes of acute cholecystitis (89 cases), pancreatitis (five
cases), and jaundice (seven cases). Twenty-seven patients had preoperative endoscopic retrograde cholangiopancreatography
(ERCP).
Results: The mean operating time was 29 ± 9 mins. Eleven procedures were converted to open surgery, (four due to bleeding, six due
to unclear anatomy, and one due to an inflammatory mass caused by gangrene/perforation). Complications occurred in 14 patients.
They included minor port site infection (four cases), pulmonary atelectasis (three cases), urinary retention (two cases),
intraoperative cathetherization not routinely performed, bile leak (two cases, both from cystic duct; one of the cystic duct
leaks occurred because of dislodgement of the occluding clip, the other may have been due to duct injury from the clip), pulmonary
embolus (one case), and myocardial infarction (one case). Neither of the latter complications were fatal. One patient required
a postoperative transfusion due to a fall in hematocrit of 3.2 gr/dl.
Conclusions: LC performed with the HS is feasible and effective. Operating time and blood loss were minimal, and the conversion rate was
low (3.9%). There were no bile duct injuries. Use of the HS makes dissection easier, thereby helping to reduce operative time
and lower the need for conversion to open surgery.
Received: 30 April 1999/Accepted: 22 November 1999/Online publication: 4 August 2000 相似文献
5.
The clinical impact of warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy 总被引:2,自引:0,他引:2
Background: Reports suggest that the insufflation of cold gas to produce a pneumoperitoneum for laparoscopic surgery can lead to an intraoperative
decrease in core body temperature and increased postoperative pain.
Methods: In a randomized controlled trial with 20 patients undergoing laparoscopic cholecystectomy, the effect of insufflation using
carbon dioxide gas warmed to 37°C (group W) was compared with insufflation using room-temperature cold (21°C) gas (group C).
Intraoperative body core and intra-abdominal temperatures were determined at the beginning and end of surgery. Postoperative
pain intensity was evaluated using a visual analog scale and recording the consumption of analgesics.
Results: There were no significant group-specific differences during the operation, neither in body temperature (group W: 36.1 ± 0.4°C
vs group C: 35.7 ± 0.6°C) nor in intra-abdominal temperature (group W: 35.9 ± 0.3°C vs group C: 35.6 ± 0.6°C). Postoperatively,
the two groups did not differ in pain susceptibility and need of analgesics.
Conclusion: The use of carbon dioxide gas warmed to body temperature to produce a pneumoperitoneum during short-term laparoscopic surgery
has no clinically important effect.
Received: 13 August 1999/Accepted: 24 September 1999/Online publication: 9 August 2000 相似文献
6.
M. Schäfer C. Suter Ch. Klaiber H. Wehrli E. Frei L. Krähenbühl 《Surgical endoscopy》1998,12(4):305-309
Background: Spilled gallstones after laparoscopic cholecystectomy may cause abscess formation, but the exact extent of this problem remains
unclear.
Method: The data (collected by the Swiss Association of Laparoscopic and Thoracoscopic Surgery) on 10,174 patients undergoing laparoscopic
cholecystectomy at 82 surgical institutions in Switzerland between January 1992 and April 1995 were retrospectively analyzed
with special interest in spilled gallstones and their complications.
Results: In 581 cases (5.7%) spillage of gallstones occurred; 34 of these cases were primarily converted to an open procedure for
stone retrieval. Of the remaining 547 cases only eight patients (0.08%) developed postoperatively abscess formation requiring
reoperation.
Conclusions: Spillage of gallstones after laparoscopic cholecystectomy is fairly common and occurs in about 6% of patients. However, abscess
formation with subsequent surgical therapy remains a minor problem. Removal of spilled gallstones is therefore not recommended
for all patients, but an attempt at removal should be performed whenever possible.
Received: 4 April 1997/Accepted: 9 July 1997 相似文献
7.
The outcome of major biliary tract injury with leakage in laparoscopic cholecystectomy 总被引:2,自引:1,他引:1
Background: Concern has been expressed regarding the increased rates of biliary tract injury (BTI) at laparoscopic cholecystectomy. The
aim of the present investigation was to analyze the outcome of laparoscopic biliary tract injury with leakage.
Methods: Sixteen patients having major laparoscopic BTI with leakage were treated. Thirteen of them were referred to our institution
for further treatment. The follow-up was complete and focused on clinical outcome and biochemical analysis.
Results: Eight BTI were identified at the time of laparoscopic cholecystectomy, and the procedure was converted to a laparotomy. In
eight additional patients, BTI was recognized postoperatively. In this group one patient died because of lately diagnosed
biliary peritonitis, whereas in the seven surviving patients nine attempts to repair the BTI and eight other interventions
were performed. In the conversion group 14 attempts to repair the BTI and 11 other interventions were needed to completely
solve the problems. Final restoration of the BTI was done by Roux-en-Y hepaticojejunostomy in 11 patients and suture repair
with T-tube drainage of the bile duct in 4. During a median follow-up time of 63 months, three patients suffered from recurrent
segmental cholangitis. In the other patients, neither clinical nor biochemical evidence of biliary disease has been found
up to this writing.
Conclusions: Laparoscopic BTI has a high morbidity and mortality rate that seems comparable to BTI at open cholecystectomy. The number
of attempts to repair the BTI as well as additional interventions is too high, but in this patient series the final outcome
seemed to be similar after BTI recognized during and after laparoscopic cholecystectomy.
Received: 3 December 1997/Accepted: 28 May 1998 相似文献
8.
Background: The objective of this study was to compare the histology of gallbladders removed prior to the introduction of laparoscopic
cholecystectomy with that found after the introduction of the laparoscopic technique to determine if there has been a change
in the indications for surgical treatment of gallbladder disease.
Methods: A retrospective review of all patients undergoing cholecystectomy during 1989, 1992, and 1993 was completed at two large
community teaching hospitals in two different geographic regions of the United States. Patients who underwent cholecystectomy
as the primary procedure were studied. A total of 1,815 cases met the criteria for analysis. Histological diagnoses were categorized
as acute cholecystitis with or without cholelithiasis, or chronic cholecystitis with cholelithiasis.
Results: The number of cholecystectomies performed increased by 58% from 1989 to 1993 (p < 0.05). The number of cholecystectomies for acute cholecystitis did not change.
Conclusions: With the advent of laparoscopic cholecystectomy, the number of cholecystectomies significantly increased and the proportion
of cholecystectomies performed for chronic disease also increased. There has been a significant change in the surgical management
of gallbladder disease with increased willingness to recommend elective cholecystectomy. Further study is needed to determine
if there is real benefit from earlier elective cholecystectomy.
Received: 25 September 1996/Accepted: 14 March 1997 相似文献
9.
The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy 总被引:11,自引:0,他引:11
Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies,
would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs
cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning,
anesthesia, and increased intra-abdominal pressure.
Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane–fentanyl
anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of
colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages.
Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15–20°) positions, and after
the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal
pressure at 13–16 mmHg), after deflation of the gas, and in the recovery room.
Results: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous
pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With
the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in
heart rate. Carbon dioxide (CO2) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary
arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values
returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas
systemic vascular resistance was decreased in comparison with the baseline.
Conclusions: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum
as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics
during laparoscopic cholecystectomy.
Received: 6 November 1998/Accepted: 8 July 1999 相似文献
10.
A case of a coincidental finding of hepatic carcinoid micrometastases, barely visible to the eye, during routine laparoscopic
cholecystectomy is reported. The micrometastases were possibly recognized as a result of a beneficial aspect of laparoscopic
surgery, namely the >10× enlargement of tissue/pathologic structures.
Received: 16 August 1996/Accepted: 28 February 1997 相似文献
11.
Duodenal perforations after laparoscopic cholecystectomies are rarely reported. The aim of this study is to focus on this
complication and to suggest ways to reduce its occurrence and avoid diagnostic mistakes and therapeutical delays that could
be fatal. We reviewed four personal cases and a number of others reported in the literature. Duodenal perforations are caused
by improper use of the irrigator-aspirator device when retracting the duodenum, or by electrosurgical and laser burns. A duodenal
perforation should be suspected in cases of bile leakage, peritonitis, intraabdominal or retroperitoneal collections, high
serum or drainage amylase concentration, absence of bile leakage from the biliary tree, and the existence of a retroduodenal
mass. Diagnosis requires a gastrografin upper GI series. Differential diagnosis is mainly with biliary lesions and other causes
of peritonitis. Relaparoscopy may require intraoperative upper GI endoscopy or Kocher's duodenal mobilization to detect the
perforation. Early diagnosis allows primary repair, usually by laparoscopy. Perforations of the duodenal cap are easier to
diagnose and have a better prognosis than those of the descending duodenum. A lumbar abscess is a frequent complication.
Received: 27 May 1998/Accepted: 14 September 1998 相似文献
12.
Background: Bile leakage is more common after laparoscopic cholecystectomy than after open surgery. In our department, the rate of postoperative
bile collections after open surgery is 0.2% vs 0.6% after laparoscopic cholecystectomy.
Methods: We studied 13 cases of intraperitoneal bile collection without common bile duct damage drawn from a total of 5,200 laparoscopic
cholecystectomies (0.23%). Clinical presentation, symptoms, method of diagnosis, causes, time of diagnosis, correlation of
time of diagnosis with definitive treatment, and postoperative results were analyzed.
Results: The symptoms appeared between the 5th and 8th postoperative days. They were observed in patients with either chronic or acute
cholecystitis. The main causes were misapplication of clips at the cystic duct and open Luschka's duct. Ultrasound failed
for early recognition of bile collections. The definitive diagnosis was made by repeat ultrasonography, CAT scan, and ERCP.
Conclusion: The ideal treatment in these cases is a minimally invasive procedure, but since the diagnosis is frequently delayed, open
surgery is performed in the majority of patients. However, there were no mortalities in this group of patients.
Received: 12 November 1998/Accepted: 15 July 1999/Online publication: 29 August 2000 相似文献
13.
Background: Intra-abdominal complications from transabdominal properitoneal (TAP) laparoscopic herniorrhaphy that would not be expected
to occur in an open herniorrhaphy are possible. In a previous study, we reported the incidence of significant intra-abdominal
adhesions from TAP herniorrhaphies using polypropylene in pigs.
Methods: To compare this with an open herniorrhaphy technique, we performed open herniorrhaphies on 31 pigs. Additional animals underwent
TAP herniorrhaphy with PTFE. Data were collected on operative and trocar-site adhesions. Graft incorporation was recorded.
Results: No intra-abdominal adhesions were found in the 31 animals undergoing open herniorrhaphy. Fifteen adhesions were found in
the 31 pigs that underwent TAP herniorrhaphy. These adhesions were graded and there were a total of nine significant adhesions
with the TAP procedure. A total of 124 trocar sites resulted in two adhesions. Laparoscopically placed polypropylene was better
incorporated than PTFE. The laparoscopically placed PTFE grafts commonly were poorly incorporated.
Conclusions: We conclude that there is a risk of intra-abdominal adhesions to either the operative site or the trocar sites in TAP herniorrhaphy
that is not present in open techniques. One should, therefore, be circumspect in the choice of TAP herniorrhaphy as a primary
repair.
Received: 8 April 1996/Accepted: 21 May 1996 相似文献
14.
Laparoscopic cholecystectomy and gallbladder cancer 总被引:2,自引:0,他引:2
Background: This study was designed to assess the treatment of patients in whom gallbladder cancer was diagnosed in the course of histological
examination of their gallbladders, which were removed during laparoscopic cholecystectomy.
Methods: Six (0.29%) cancers were found among 2,017 patients who underwent laparoscopic cholecystectomy. Four of these cancers (0.22%)
were in 1,831 gallbladders with normal walls, two (1.0%) were in 186 with thicker walls, and two (1.8%) were in 109 patients
in whom conversion was necessary because of extensive inflammation and thickening of gallbladder wall.
Results: In two cases, the cancer did not cross the muscular layer. In one of them, no further treatment was undertaken. In the second
case, liver resection and lymphadenectomy was performed. In the other four cases, dissemination was diagnosed during laparotomy,
precluding radical treatment.
Conclusions: Thickened and infiltrated gallbladder walls in patients without preoperative symptoms of cholecystitis should raise a suspicion
of cancer. The surgeon should be prepared to perform a conversion, an intraoperative histological examination, and an appropriate
radical operation, if necessary.
Received: 16 June 1998/Accepted: 17 November 1998 相似文献
15.
Background: In spite of the emergence of laparoscopic cholecystectomy as the gold standard for treatment of symptomatic gallstones, questions
still remain regarding its overall cost effectiveness, especially at low-volume centers where operating room (OR) time and
operative complications are higher. We hypothesize that the presence of a well-organized, dedicated laparoscopic OR team will
improve surgical outcomes for this procedure. This study compares the operative results of an advanced and a basic laparoscopic
surgeon using either a designated laparoscopic operating team or a nondesignated team.
Methods: The hospital records for 71 elective laparoscopic cholecystectomies with cholangiograms were retrospectively reviewed and
anesthesia times and conversion rates were analyzed. Procedures were performed either at a hospital with a dedicated laparoscopy
team or a hospital with nondedicated OR personnel. All procedures were done by an advanced laparoscopic surgeon or a basic
laparoscopic surgeon.
Results: Case characteristics were evenly matched between sites and surgeons. The mean total anesthesia time at the dedicated site
was 120.8 min, compared to 152.3 min at the nondedicated site with a mean difference of 31.5 min (p= 0.001). A 12% conversion rate was documented at the nondedicated site. There were no conversions at the site with a dedicated
laparoscopy team. No major complications were encountered in this series.
Conclusion: This study demonstrates that having a designated laparoscopic trained team provides a time savings to both advanced and basic
laparoscopic surgeons. Although no major complications were encountered, there was a significant conversion rate for the less
experienced surgeon operating without the support of a trained team. The end result from having a dedicated team in endoscopic
surgery is decreased operative time, an improvement in patient care, and decreased costs to the patient and institution.
Received: 5 July 1996/Accepted: 9 January 1997 相似文献
16.
Background: Pneumoperitoneum (PP) for laparoscopic surgery induces prompt changes in circulatory parameters. The rapid onset of these
changes suggests a reflex origin, and the present study was undertaken to evaluate whether release of vasopressor substances
could be responsible for these alterations. The influence of two different anesthesia techniques was also evaluated.
Methods: American Society of Anesthesiologists (ASA) class I patients, scheduled for laparoscopic cholecystectomy, were investigated.
The first group (n= 10) was anesthetized intravenously. The second group (n= 6) had inhalation anesthesia. Plasma vasopressin, catecholamines, and plasma renin activity were investigated as neurohumoral
vasopressor markers of circulatory stress. The general stress response to surgery was assessed by analysis of plasma cortisol.
Results: Induction of pneumoperitoneum caused no apparent activation of vasopressor substances, although several hemodynamic parameters
responded promptly.
Conclusion: The hemodynamic alterations, seen at the establishment of PP during stable anesthesia, cannot be explained by elevation of
vasopressor substances in circulating blood.
Received: 7 April 1997/Accepted: 3 December 1997 相似文献
17.
The charts of all patients with acute cholecystitis undergoing either laparoscopic or minilap cholecystectomy at the Chinle Comprehensive Health Care Facility between October 1, 1991, and August 15, 1993, were retrospectively reviewed. During that period, 54 patients underwent laparoscopic cholecystectomy and 45 patients had minilap procedures. The two groups had similar mean age, sex distribution, temperature, leukocyte count, gallbladder wall thickness, and duration of preoperative symptoms. While laparoscopic cholecystectomy took an average of 16 min longer to perform than minilap cholecystectomy, patients who had laparoscopic cholecystectomy had less blood loss, reduced postoperative narcotic needs, and shorter hospital stays. 相似文献
18.
Background: The cardiopulmonary changes experienced by patients who undergo laparoscopic cholecystectomy (LC) and the prognostic value
of patient characteristics are not well understood.
Methods: Cardiorespiratory changes were investigated in 120 patients undergoing LC or open cholecystectomy (OC). The results and their
relation to patient variables were statistically evaluated.
Results: The most significant cardiorespiratory changes were (A-a)PO2 increase during OC; decrease of pH and compliance and increase of peak airway pressure during LC; impairment of arterial
blood gas mean values and respiratory muscle strength; atelectasis and pneumonia (five cases) after OC; and lamellar atelectasis
(two cases) after LC. Significant adverse prognostic factors related to intra- and postoperative LC cardiorespiratory changes
were ASA class greater than I, FEF75–85% < 900 ml, and PaO2 < 10.4 kPa (PPV, 71.4% and 46.6%, respectively).
Conclusions: LC carries no significant cardiorespiratory changes provided that intraoperative monitoring of hemodynamics and respiratory
parameters is done for the study of blood gas values in all patients at risk. 相似文献
19.
Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopoic or open cholecystectomy 总被引:2,自引:0,他引:2
Yoshida S Ohta J Yamasaki K Kamei H Harada Y Yahara T Kaibara A Ozaki K Tajiri T Shirouzu K 《Surgical endoscopy》2000,14(2):137-140
Background: Endogenous morphine in the brain leads to various biological responses after surgery. The aim of this study was to determine
whether morphine levels in the plasma would be enhanced by open laparotomy rather than by laparoscopic procedures.
Methods: We compared 19 patients who underwent laparoscopic cholecystectomy with five patients who underwent resection of the gallbladder
by open laparotomy. Morphine levels in the plasma were measured by an electrochemical detection system.
Results: Postoperative endogenous morphine levels were higher with open laparotomy than with the laparoscopic technique (three h after
surgery: open, 200 ± 52.6 fmol/ml vs laparoscopy, 17.6 ± 3.7, p < 0.01). This morphine elevation accounted for higher levels of cytokine, greater pain scores, and longer duration of fasting
in open laparotomized patients than in laparoscopic cholecystectomy patients. Stress hormone levels in the plasma were also
higher with open laparotomy than with laparoscopy.
Conclusion: Morphine synthesis was enhanced by open laparotomy, resulting in greater biological response postoperatively than that seen
with laparoscopic cholecystectomy.
Received: 21 October 1998/Accepted: 3 April 1999 相似文献
20.
D. Collet 《Surgical endoscopy》1997,11(1):56-63
Background: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation
as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of
laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the
beginning years in which the technique was being used.
Methods: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy
started laparoscopically during 1994 have been included.
Results: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 ± 19.8 years old) and 1,314 males
(56.3 ± 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while
4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N= 230)—4.7% in group I (N= 203) and 8.4% in group II (N= 27). Mortality was 0.2% (N= 9)—namely four intraabdominal complications (three cases of peritonitis and one biliary reoperation), two cardiac failures,
and one brain infarction. The causes of death were not specified in two patients.
Conclusions: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas
the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These
results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient
and the biliary symptoms.
Received: 25 January 1996/Accepted: 10 April 1996 相似文献