腹腔镜胆囊切除与小切口胆囊切除的比较

A Comparison of Laparoscopic with Minilaparotomy Cholecystectomy

为比较腹腔镜胆囊切除（ＬＣ）与小切口胆囊切除（ＭＣ）的临床应用效果，自１９９３年９月～１９９５年７月，将同期收治的胆囊良性病变的病例分为ＬＣ组和ＭＣ组。ＬＣ组１１５例，治愈１０９例（９４．８％），中转ＭＣ５例，再次手术１例；ＭＣ组５７例，治愈５２例（９１．２％），延长切口５例。两组术后无出血、胆瘘、胆管损伤及肠穿孔等严重并发症。比较两组结果：在创伤疼痛、止痛剂、抗菌素用量、机体康复、住院时间及美容等方面，ＬＣ优于ＭＣ；术中出血量及手术时间两组无差异。提示：ＬＣ中转手术时应取ＭＣ；手术困难时，应掌握好ＬＣ及时中转ＭＣ及ＭＣ适当延长切口的指征。

In order to compare the effect of clinical application of laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC), from September 1993 to July 1995, we divided 172 patients with benign cholecystopathy into LC (115 cases) and MC (57 cases) groups. Two procedures had been performed by the same surgeons. 94.8% of patients in the LC group and 91.2% of patients in the MC group had been completely cured respectively. In the LC group, five cases had to be converted to MC and one was reoperated; while in the MC group the incision was extended in 5 cases. No homorrhage, biliary fistula, bile duct injury, intestinal perforation and other severe complication were observed after operation in both groups. Compared the results of LC with MC, LC had faster recuperation, shorter hospitalization, less injury, less postoperative pain and depression, less use of narcotic, antibiotics. There was no significant difference in operative bleeding and operation time between the two groups. The authors advocate that MC should be applied when LC has to be converted to an open operation and the indications and timing should be handed correctly for the convertion of LC to MC and incision should be prolonged proportionally when operation runs into difficulty in MC.