The analysis of 1240 cases of laparoscopic cholecystectomy performed during the day time
-
摘要: 目的探讨日间手术腹腔镜胆囊切除(LC/DS)的可行性和安全性,评价65岁以上老年患者LC/DS手术的效果。方法回顾性分析2009年11月至2010年12月我院1240例LC/DS临床资料,分析其并发症、延迟出院和再入院原因。比较65岁以下和老年患者LC/DS治疗效果。结果 1240例中1236例LC/DS手术成功,中转开腹4例(0.32%)。共发生6例(0.48%)并发症。延迟出院125例(10.1%),其中49例(39.2%)因心理因素延迟出院,34例(27.2%)因手术后呕吐和腹痛延迟出院。再入院15例(1.2%),8例因胆囊癌再入院。老年患者LC/DS无严重并发症,患者满意度与65岁以下组差异无统计学意义(P>0.05),延迟出院和再入院比例高于65岁以下组(P<0.01)。结论日间手术腹腔镜胆囊切除安全可行,经选择的老年患者同样适合LC/DS医疗模式。心理因素、呕吐和腹痛是导致患者延迟出院的主要原因。Abstract: Objective To explore the feasibility and safety of day surgery laparoscopic cholecystectomy (LC/DS) , and to evaluate the outcome of LC/DS in aged patients (more than 65 years) .Methods 1240 patients undergoing LC/DS in our hospital between November 2009 and December 2010 were retrospectively studied.The complications and reasons of delayed discharge and readmission were analyzed.The treatment effectiveness of LC/DS in aged patients was compared with that of patients younger than 65 years.Results Among 1240 patients of LC/DS group, 1236 cases were preformed by LC and 4 cases were conversd to laparotomy (0.32%) .Complications were developed in six cases (0.48%) .125 (10.1%) patients were not discharged within 24 hours of the operation, among whom 49 (39.2%) refused discharge for psychological factor, 34 (27.2%) for postoperative omitting and abdominal pain.15 patients were readmitted, among whom 8 cases were unexpected gallbladder carcinomas.There was no significant complications in aged patients.The satisfaction rate has no difference compared with that of patients younger than 65 years (P>0.05) , while rate of delayed discharge and readmission rate in aged patients group was higher than in patients younger than 65 years (P<0.01) .Conclusion The day surgery laparoscopic cholecystectomy is feasibile and safe, the day surgery procedure is also suitable for selected aged patients.Psychological factor, postoperative vomitting and abdominal pain are the main causes of delayed discharge.
-
Key words:
- gallbladder diseases /
- cholecystectomy /
- laparoscopic
-
[1]Briggs CD, Irving GB, Mann CD, et al.Introduction of aday-case laparoscopic cholecystectomy service in the UK:acritical analysis of factors influencing same-day dischargeand contact with primary care providers[J].Ann R Coll SurgEngl, 2009, 91 (7) :583-590. [1]Briggs CD, Irving GB, Mann CD, et al.Introduction of aday-case laparoscopic cholecystectomy service in the UK:acritical analysis of factors influencing same-day dischargeand contact with primary care providers[J].Ann R Coll SurgEngl, 2009, 91 (7) :583-590. [2]Jakobsen HL, G genur I, Jacobsen B, et al.Laparoscopiccholecystectomy as an outpatient procedure[J].UgeskrLaeger, 2005, 167 (24) :2641-2643. [2]Jakobsen HL, G genur I, Jacobsen B, et al.Laparoscopiccholecystectomy as an outpatient procedure[J].UgeskrLaeger, 2005, 167 (24) :2641-2643. [3]Proske JM, Dagher I, Revitea C, et al.Day-case laparo-scopic cholecystectomy:results of 211 consecutive patients[J].Gastroenterol Clin Biol, 2007, 31 (4) :421-424. [3]Proske JM, Dagher I, Revitea C, et al.Day-case laparo-scopic cholecystectomy:results of 211 consecutive patients[J].Gastroenterol Clin Biol, 2007, 31 (4) :421-424. [4]Lam D, Miranda R, Hom SJ.Laparoscopic cholecystectomyas an outpatient procedure[J].J Am Coll Surg, 1997, 185 (2) :152-155. [4]Lam D, Miranda R, Hom SJ.Laparoscopic cholecystectomyas an outpatient procedure[J].J Am Coll Surg, 1997, 185 (2) :152-155. [5]Bal S, Reddy LG, Parshad R, et al.Feasibility and safety ofday care laparoscopic cholecystectomy in a developing coun-try[J].Postgrad Med J, 2003, 79 (931) :284-288. [5]Bal S, Reddy LG, Parshad R, et al.Feasibility and safety ofday care laparoscopic cholecystectomy in a developing coun-try[J].Postgrad Med J, 2003, 79 (931) :284-288. [6]李可为, 丁俊, 陈涛, 等.日间腹腔镜胆囊切除术25例分析[J].肝胆胰外科杂志, 2010, 22 (1) :48-49. [6]李可为, 丁俊, 陈涛, 等.日间腹腔镜胆囊切除术25例分析[J].肝胆胰外科杂志, 2010, 22 (1) :48-49. [7]Ji W, Ding K, Li LT, et al.Outpatient versus inpatient lapa-roscopic cholecystectomy:a single center clinical analysis[J].Hepatobiliary Pancreat Dis Int, 2010, 9 (1) :60-64. [7]Ji W, Ding K, Li LT, et al.Outpatient versus inpatient lapa-roscopic cholecystectomy:a single center clinical analysis[J].Hepatobiliary Pancreat Dis Int, 2010, 9 (1) :60-64. [8]Marakis GN, Pavlidis TE, Ballas K, et al.Major complica-tions during laparoscopic cholecystectomy[J].Int Surg, 2007, 92 (3) :142-146. [8]Marakis GN, Pavlidis TE, Ballas K, et al.Major complica-tions during laparoscopic cholecystectomy[J].Int Surg, 2007, 92 (3) :142-146. [9]Murphy MM, Ng SC, Simons JP, et al.Predictors of majorcomplications after laparoscopic cholecystectomy:surgeon, hospital, or patient?[J].J Am Coll Surg, 2010, 211 (1) :73-80. [9]Murphy MM, Ng SC, Simons JP, et al.Predictors of majorcomplications after laparoscopic cholecystectomy:surgeon, hospital, or patient?[J].J Am Coll Surg, 2010, 211 (1) :73-80. [10]Proske JM, Dagher I, Revitea C, et al.Day-case laparo-scopic cholecystectomy:results of 211 consecutive patients[J].Gastroenterol Clin Biol, 2007, 31 (4) :421-424. [10]Proske JM, Dagher I, Revitea C, et al.Day-case laparo-scopic cholecystectomy:results of 211 consecutive patients[J].Gastroenterol Clin Biol, 2007, 31 (4) :421-424. [11]Schmidt SC, Langrehr JM, Hintze RE, et al.Long-term re-sults and risk factors influencing outcome of major bile ductinjuries following cholecystectomy[J].Br J Surg, 2005, 92 (1) :76-82. [11]Schmidt SC, Langrehr JM, Hintze RE, et al.Long-term re-sults and risk factors influencing outcome of major bile ductinjuries following cholecystectomy[J].Br J Surg, 2005, 92 (1) :76-82. [12]Russell JC, Walsh SJ, Mattie AS, et al.Bile duct injuries, 1989-1993.A statewide experience.Connecticut laparo-scopic cholecystectomy registry[J].Arch Surg, 1996, 131 (4) :382-388. [12]Russell JC, Walsh SJ, Mattie AS, et al.Bile duct injuries, 1989-1993.A statewide experience.Connecticut laparo-scopic cholecystectomy registry[J].Arch Surg, 1996, 131 (4) :382-388. [13]Richardson MC, Bell G, Fullarton GM.Incidence and natureof bile duct injuries following laparoscopic cholecystectomy:an audit of 5913 cases.West of Scotland Laparoscopic Chol-ecystectomy Audit Group[J].Br J Surg, 1996, 83 (10) :1356-1360. [13]Richardson MC, Bell G, Fullarton GM.Incidence and natureof bile duct injuries following laparoscopic cholecystectomy:an audit of 5913 cases.West of Scotland Laparoscopic Chol-ecystectomy Audit Group[J].Br J Surg, 1996, 83 (10) :1356-1360. [14]Deziel DJ, Millikan KW, Economou SG, et al.Complicationsof laparoscopic cholecystectomy:anational survey of 4, 292hospitals and an analysis of 77, 604 cases[J].Am J Surg, 1993, 165 (1) :9-14. [14]Deziel DJ, Millikan KW, Economou SG, et al.Complicationsof laparoscopic cholecystectomy:anational survey of 4, 292hospitals and an analysis of 77, 604 cases[J].Am J Surg, 1993, 165 (1) :9-14. [15]Archer SB, Brown DW, Smith CD, et al.Bile duct injury dur-ing laparoscopic cholecystectomy:results of a national sur-vey[J].Ann Surg, 2001, 234 (4) :549-559. [15]Archer SB, Brown DW, Smith CD, et al.Bile duct injury dur-ing laparoscopic cholecystectomy:results of a national sur-vey[J].Ann Surg, 2001, 234 (4) :549-559. [16]Nuzzo G, Giuliante F, GiovanniniI, et al.Bile duct Injury dur-ing laparoscopic cholecystectomy results of an italian nationalsurvey on 56 591 cholecystectomies[J].Arch Surg, 2005, 140 (10) :986-992. [16]Nuzzo G, Giuliante F, GiovanniniI, et al.Bile duct Injury dur-ing laparoscopic cholecystectomy results of an italian nationalsurvey on 56 591 cholecystectomies[J].Arch Surg, 2005, 140 (10) :986-992. [17]Ghnnam W, Malek J, Shebl E, et al.Rate of conversion andcomplications of laparoscopic cholecystectomy in a tertiarycare center in Saudi Arabia[J].Ann Saudi Med, 2010, 30 (2) :145-148. [17]Ghnnam W, Malek J, Shebl E, et al.Rate of conversion andcomplications of laparoscopic cholecystectomy in a tertiarycare center in Saudi Arabia[J].Ann Saudi Med, 2010, 30 (2) :145-148. [18]Singh K, Ohri A.Laparoscopic cholecystectomy-is there aneed to convert?[J].J Minim Access Surg, 2005, 1 (2) :59-62. [18]Singh K, Ohri A.Laparoscopic cholecystectomy-is there aneed to convert?[J].J Minim Access Surg, 2005, 1 (2) :59-62. [19]Al Ghamdi AS, Khamis HS, El Shawatfy El Said R, et al.Laparoscopic cholecystectomy:the outcome with minimalconversion rate:experience in adistrict hospital[J].Saudi JGastroenterol, 2003, 9 (3) :124-128. [19]Al Ghamdi AS, Khamis HS, El Shawatfy El Said R, et al.Laparoscopic cholecystectomy:the outcome with minimalconversion rate:experience in adistrict hospital[J].Saudi JGastroenterol, 2003, 9 (3) :124-128. [20]Chandio A, Timmons S, Majeed A, et al.Factors influencingthe successful completion of laparoscopic cholecystectomy[J].JSLS, 2009, 13 (4) :581-586. [20]Chandio A, Timmons S, Majeed A, et al.Factors influencingthe successful completion of laparoscopic cholecystectomy[J].JSLS, 2009, 13 (4) :581-586. [21]Rosen M, Brody F, Ponsky J.Predictive factors for conver-sion of laparoscopic cholecystectomy[J].Am J Surg, 2002, 184 (3) :254-258. [21]Rosen M, Brody F, Ponsky J.Predictive factors for conver-sion of laparoscopic cholecystectomy[J].Am J Surg, 2002, 184 (3) :254-258. [22]Takegami K, Kawaguchi Y, NakayamaH, et al.Preoperativegrading system for predicting operative conditions in laparo-scopic cholecystectomy[J].Surg Today, 2004, 34 (4) :331-336. [22]Takegami K, Kawaguchi Y, NakayamaH, et al.Preoperativegrading system for predicting operative conditions in laparo-scopic cholecystectomy[J].Surg Today, 2004, 34 (4) :331-336. [23]Psaila J, Agrawal S, Fountain U, et al.Day-surgery laparo-scopic cholecystectomy:factors influencing same-day dis-charge[J].World J Surg, 2008, 32 (1) :76-81. [23]Psaila J, Agrawal S, Fountain U, et al.Day-surgery laparo-scopic cholecystectomy:factors influencing same-day dis-charge[J].World J Surg, 2008, 32 (1) :76-81. [24]Victorzon M, Tolonen P, Vuorialho T.Day-case laparoscop-ic cholecystectomy:treatment of choice for selected pa-tients?[J].Surg Endosc, 2007, 21 (1) :70-73. [24]Victorzon M, Tolonen P, Vuorialho T.Day-case laparoscop-ic cholecystectomy:treatment of choice for selected pa-tients?[J].Surg Endosc, 2007, 21 (1) :70-73. [25]1Metcalfe MS, Mullin EJ, Maddern GJ.Relaxation of thecriteria for day surgery laparoscopic cholecystectomy[J].ANZ J Surg, 2006, 76 (3) :142-144. [25]1Metcalfe MS, Mullin EJ, Maddern GJ.Relaxation of thecriteria for day surgery laparoscopic cholecystectomy[J].ANZ J Surg, 2006, 76 (3) :142-144.
本文二维码
计量
- 文章访问数: 3823
- HTML全文浏览量: 16
- PDF下载量: 732
- 被引次数: 0