Laparoscopic cholecystectomy: a report on 2000 cases.
Laparoscopic cholecystectomy: a report on 2000 cases.
复制标题
腹腔镜胆囊切除术2000例报告.
作者：
O. Fathy;M. A. Zeid;T. Abdallah;A. Fouad;A. A. Eleinien;N. G. El;G. Eleibiedy;M. A. El‐Wahab;A. Sultan;N. Anwar;F. Ezzat
背景/目标
本文是对同一中心2000例腹腔镜胆囊切除术后的结果进行回顾分析。
方法论
自1992年6月至2000年2月，2000例有症状的胆石症患者(女性1458例，男性542例，平均年龄39.8岁)接受了腹腔镜胆囊切除术。所有病例均经腹部超声检查确诊。31例术前行内窥镜逆行胰胆管造影。除20例外，其余均采用4枚套管针。
结果
平均手术时间45±15分钟。中转开腹手术147例(7.35%)。粘连是最常见的中转原因(2.9%)。没有与技术相关的死亡。胆管损伤7例(0.35%)，5例行肝总管空肠Rouxen-Y吻合术，2例经内窥镜支架成功修复。胆漏11例(0.55%)，腹膜炎5例(0.25%)，内出血9例(0.45%)，囊性动脉损伤17例(0.85%)，气胸1例(0.05%)，皮下气肿3例(0.15%)。
结论
腹腔镜胆囊切除术是一种可以接受的并发症，是开腹胆囊切除术的一种很好的替代方案。在适当的时候改行开腹胆囊切除术，可以预防严重的并发症。
BACKGROUND/AIMS
This is a retrospective study to evaluate the results of laparoscopic cholecystectomy after 2000 cases at a single center.
METHODOLOGY
Between June 1992 and February 2000, 2000 patients (1458 females and 542 males, mean age 39.8 years) with symptomatic gallstones underwent laparoscopic cholecystectomy. All cases were diagnosed by abdominal ultrasonography. Preoperative endoscopic retrograde cholangiopancreatography was done for 31 patients. Four trocars were used for all except 20 cases.
RESULTS
The mean operative time was 45 +/- 15 minutes. Conversion to open cholecystectomy occurred in 147 patients (7.35%). Adhesions were the commonest cause of conversion (2.9%). There was no technique-related mortality. Bile duct injury occurred in 7 cases (0.35%), reconstruction by Rouxen-Y hepaticojejunostomy was necessary in 5 cases and the injury was successfully managed by endoscopic stent in 2 cases. Bile leakage occurred in 11 cases (0.55%), peritonitis in 5 cases (0.25%), internal hemorrhage in 9 cases (0.45%), cystic artery injury in 17 cases (0.85%), pneumothorax in one case (0.05%) and subcutaneous emphysema in 3 cases (0.15%).
CONCLUSIONS
Laparoscopic cholecystectomy is a good alternative to open cholecystectomy with an acceptable morbidity. Conversion to open cholecystectomy at the proper time will prevent major complications.