摘要
目的探讨腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）不过夜日间手术的安全性及可行性。方法回顾性分析2015年1～6月78例不过夜日间LC的临床资料。经门诊筛查,术前诊断为单纯胆囊良性疾病（胆囊结石、胆囊息肉样病变）,未合并严重的心肺基础疾病,无上腹部手术史,且同意接受日间不过夜胆囊切除术。结果 74例（94.9%）成功完成手术并于术后4 h内离院,其中2例术中经胆囊管置入胆道镜行胆道探查（laparoscopic transcyctic common bile duct exploration,LTCBDE）。4例（5.1%）留院观察,其中1例（1.3%）因术中发现Mirizzi综合征Ⅰ型,留置腹腔引流,2例（2.6%）因术后恶心、呕吐,1例（1.3%）在术后恢复室内出现舌后坠导致气道堵塞、缺氧,均于24 h内出院。手术时间35～152 min,（80.0±19.7）min;住院费用5688～9768元,（8318.0±848.5）元;住院时间5.6～23.9 h,中位数7.4 h。术后当日、术后第1日及术后第7日随访无严重并发症。结论日间手术安全、可行,值得推广。但必须严格筛选病例,并由经验丰富的手术医师、麻醉医师和护理人员密切协作。
Objective To explore the feasibility and safety of day surgery laparoscopic cholecystectomy. Methods From January 2015 to June 2015, 78 cases of clay-case laparoscopic cholecystectomy were performed in our hospital. The clinical data were retrospectively reviewed. These patients were diagnosed as having cholclithiasis or cholecystic poypus. They had no severe heart or lung diseases, no history of epigastric operation, and agreed to accept day-case laparoscopic cholecystectomy without overnight hospitalization. Results Of the 78 patients, 74 patients （94.9%） successfully accepted the surgery and were discharged no more than 4 h after surgery, including 2 patients with combined laparoscopic transcyctic common bile duct exploration （LTCBDE）. remaining 4 patients （5.1%） were admitted for overnight hospital stay, including 1 patient （ 1.3% ） with Mirizzi syndrome typ The e I who was given abdominal drainage, 2 patients （2.6%） with severe nausea and vomit, 1 patient （1.3%） with airway obstruction after operation. All the 4 patients were discharged within 24 h after the surgery. The operating time was 35 - 152 rain （ mean, 80.0 ±19.7 min）. The hospitalization expenses was 5688 - 9768 yuan （mean, 8318.0 - 848.5 yuan）. The hospitalization time was 5.6 - 23.9 h （median, 7.4 h）. Postoperative follow-up at the day of surgery, the first and the seventh postoperative day showed that none of the patients strictly suffered from severe complications. Conclusion Day-case laparoscopic cholecystectomy is safe and feasible, on the basis of selected patients, experienced surgeons, and close cooperation with anesthetists and nurses.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第9期780-783,共4页
Chinese Journal of Minimally Invasive Surgery
基金
北京市卫生系统高层次卫生技术人才培养项目资助(2013-3-061)
关键词
腹腔镜胆囊切除
日间手术
快速康复外科
Laparoscopic cholecystectomy
Day-case surgery
Fast track surgery
