BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC com...BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay,costs, and the outcomes of patients undergoing LC.DATA SOURCES： Data were extracted from the following databases： PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index（CMCI）,Chinese Medical Current Contents（CMCC）, and China BioMedical Literature Database（CBM）. We also searched the reference lists of the relevant articles and conference articles.Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software（version 5.0）.RESULTS： A total of 7 trials with 1187 patients were included.The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95%CI：-2.65 to-1.16, P〈0.00001], lower cost [standard mean difference=-0.69, 95% CI：-0.82 to-0.56, P〈0.00001], and better questionnaires based satisfaction with the medical services.CONCLUSIONS： The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However,there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.展开更多
Objective To analyze the complications of laparoscopic cholecystectomy (LC) and their affecting factors and investigate their prevention and treatment. Methods The clinical data of 18 726 patients treated with LC betw...Objective To analyze the complications of laparoscopic cholecystectomy (LC) and their affecting factors and investigate their prevention and treatment. Methods The clinical data of 18 726 patients treated with LC between March 1992 to January 2001 in our hospital were retrospectively analyzed. Results The complications were common bile duct injury in 28 cases (0. 15%), bile leakage in 62 (0. 33% ), introabdominal hemorrhage in 6 (0.03) and postoperative introabdominal abscess in 4 (0. 02). The causes for these complications were improper choice of indications and surgeon’s back of knowledge and experience in identifying the abnormality of bile duct anatomy. Conclusion The major complications of LC are bile duct leakage and injury. The injury can be avoided through careful performance of LC. Immediate discovery and proper treatment will result in good outcome.7 refs.1 fig,2 tabs.展开更多
基金supported by a grant from the National Key Technology ResearchDevelopment Program of China(2008BAH27B06)
文摘BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay,costs, and the outcomes of patients undergoing LC.DATA SOURCES： Data were extracted from the following databases： PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index（CMCI）,Chinese Medical Current Contents（CMCC）, and China BioMedical Literature Database（CBM）. We also searched the reference lists of the relevant articles and conference articles.Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software（version 5.0）.RESULTS： A total of 7 trials with 1187 patients were included.The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95%CI：-2.65 to-1.16, P〈0.00001], lower cost [standard mean difference=-0.69, 95% CI：-0.82 to-0.56, P〈0.00001], and better questionnaires based satisfaction with the medical services.CONCLUSIONS： The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However,there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.
文摘Objective To analyze the complications of laparoscopic cholecystectomy (LC) and their affecting factors and investigate their prevention and treatment. Methods The clinical data of 18 726 patients treated with LC between March 1992 to January 2001 in our hospital were retrospectively analyzed. Results The complications were common bile duct injury in 28 cases (0. 15%), bile leakage in 62 (0. 33% ), introabdominal hemorrhage in 6 (0.03) and postoperative introabdominal abscess in 4 (0. 02). The causes for these complications were improper choice of indications and surgeon’s back of knowledge and experience in identifying the abnormality of bile duct anatomy. Conclusion The major complications of LC are bile duct leakage and injury. The injury can be avoided through careful performance of LC. Immediate discovery and proper treatment will result in good outcome.7 refs.1 fig,2 tabs.
