门诊腹腔镜胆囊切除术与住院腹腔镜胆囊切除术的对照研究  

Outpatient versus inpatient laparoscopic cholecystectomy:A case-control study

作　　者：嵇武[1] 丁凯[1] 王丹[1] 刘兴东[1] 范铭兴[1] 李令堂[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院全军普通外科研究所,南京医学博士210002

出　　处：《医学研究生学报》2010年第3期258-262,共5页Journal of Medical Postgraduates

基　　金：全军医药卫生科研专项基金(08Z007)

摘　　要：目的门诊腹腔镜胆囊切除术(out-patient laparoscopic cholecystectomy,OPLC)在国外一些医疗中心已得到应用,效果良好,但在我国大陆尚未开展。文中探讨在国内开展OPLC的可行性、安全性、优势和患者的接受程度。方法200例良性胆囊疾病患者,分为OPLC组100例,住院腹腔镜胆囊切除术(in-patient laparoscopic cholecystectomy,IPLC)组100例,观察手术成功率、手术时间、术中出血、术后恢复进食时间、并发症发生率、术后留院时间和总治疗费用。术后2周随访患者满意程度。结果IPLC组手术成功率99%,平均手术时间(24.0±8.2)min,估计术中出血(16.2±7.5)ml,患者术后恢复进流质时间(10.7±1.4)h,恢复进半流饮食时间(22.0±2.6)h,术后平均留院观察时间(58.2±19.5)h,1例出现泌尿系统感染,1例出现轻度切口感染,平均总费用(8770.5±365.6)元。术后2周均获随访,总体满意率90%。OPLC组手术成功率99%,手术时间(21.6±9.4)min,术中出血(14.7±6.8)ml,患者术后恢复进流质时间(11.3±1.9)h,恢复进半流饮食时间(20.1±4.8)h,术后平均留院观察(28.5±6.4)h,89例在术后1 d回家,11例在术后2 d回家,2例出现局部并发症,平均总费用(7235.7±415.8)元,比IPLC组组减少17.5%。术后2周均获随访,总体满意率94%。研究表明,OPLC在手术成功率、手术时间、术中出血、术后恢复进食时间及手术并发症发生率、总体满意度等方面与IPLC无明显差异(P>0.05),在术后留院时间和总治疗费用方面与IPLC存在显著差异(P<0.05),表现为OPLC的留院时间明显缩短,治疗费用明显减少。结论OPLC在我国开展是可行的、安全的、患者可以接受的,它可显著缩短患者手术等待时间,有效提高医院的床位周转,大大减少患者住院的不适感,一定程度上降低治疗费用,但目前尚有许多问题需要解决。Objective Outpatient laparoscopic cholecystectomy（OPLC） prevails in some developed countries as one of fast-track surgeries performed in the ambulatory centers,but has not yet become a routine practice in China.This study was designed to report the feasibility,safety,benefits and patients′ acceptance of OPLC.Methods We equally divided 200 patients with benign gallbladder diseases into an OPLC and an inpatient laparoscopic cholecystectomy（IPLC） group,and retrospectively analyzed such data as the success rate of laparoscopic cholecystectomy（LC）,duration of surgery,blood loss in operation,time of diet resumption,incidence of complication,time of post-operative hospital stay and total cost of treatment.All the patients were followed up 2 weeks after the operation.Results In the IPLC and OPLC groups,the success rates of LC were both 99%,the operation durations were 24.0 ± 8.2 min and 21.6 ± 9.4 min,the operative blood losses were 16.2 ± 7.5 ml and 14.7 ± 6.8 ml,the times of liquid food resumption were 10.7 ± 1.4 h and 11.3 ± 1.9 h,the times of semi-liquid food resumption were 22.0 ± 2.6 h and 20.1 ± 4.8 h,the times of postoperative hospital observation were 58.2 ± 19.5 h and 28.5 ± 6.4 h,the incidences of complication were 1%（a case of mild urinary infection） and 2%（2 cases of local complication）,the total costs of treatment were 8 770.5 ± 365.6 yuan and 7 235.7 ± 415.8 yuan（decreased by 17.5% in the latter）,and the satisfaction rates of the patients were 90% and 94%,respectively.There were no significant differences in the success rate of LC,operative blood loss and duration,time of diet resumption,incidence of complication and patients′ satisfaction with the operation between the two groups.However,the time of post-operative hospital stay was significantly shorter and total cost of treatment significantly less in the OPLC than in the IPLC group.Conclusion OPLC is safe,feasible and acceptable,for it can significantly shorten patients′ waiting time before surgery,speed up turn

关 键 词：腹腔镜胆囊切除术 门诊手术 加速康复外科 

分 类 号：R657.4[医药卫生—外科学]