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Surgical treatment of gallstone disease - always laparoscopic?

机译：手术治疗胆结石病 - 始终腹腔镜？

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Twenty years ago open cholecystectomy was the gold standard for surgical removal of the gallbladder in patients with symptomatic gallstones. The results were excellent, the complication rate rather low. Nevertheless, surgical technique in gallbladder surgery has completely changed since the introduction of minimally invasive techniques in abdominal surgery. In the meanwhile, laparoscopic cholecystectomy clearly is the new gold standard for removal of the gallbladder. The reasons for this dramatic change in operative technique are clear. First, the cosmetic result after laparoscopic cholecystectomy with four very small incisions is clearly better than after open cholecystectomy. This point certainly is most impressive for patients. In addition it is clear that, due to the avoidance of large incisions, operative trauma for the patient is significantly less in laparoscopic cholecystectomy. This can be shown by a reduced stay in hospital and a dramatically reduced period of sick leave. Thus, the question arises whether there is still a place for open cholecystectomy. In order to answer this question the specific side-effects of laparoscopic cholecystectomy have to be analysed. The following three problems will be discussed below: (a) the potential cardiopulmonary side-effects, (b) the potential risk for tumour cell spillage and (c) the risk of bile duct injury.
机译：二十年前，开放的胆囊切除术是患有症状胆结石患者的胆囊外科手术去除的金标准。结果优异，并发症率相当低。然而，自腹部手术中引入微创技术以来，胆囊手术中的手术技术完全改变。同时，腹腔镜胆囊切除术显然是用于去除胆囊的新金标准。操作技术中这种戏剧性变化的原因很清楚。首先，腹腔镜胆囊切除术与四个非常小的切片后的化妆品结果显然比开放的胆囊切除术后更好。这一点肯定对患者最令人印象深刻。另外很明显的是，由于避免了大的切口，为患者手术创伤显著少是在腹腔镜胆囊切除术。这可以通过减少住院和大幅减少的病假。因此，问题出现了是否存在开放性胆囊切除术的地方。为了回答这个问题，必须分析腹腔镜胆囊切除术的具体副作用。以下三个问题将在下面讨论：（a）潜在的心肺副作用，（b）肿瘤细胞溢出的潜在风险和（c）胆管损伤的风险。

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    《Falk Symposium》|2004年||共5页
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  • 中图分类 胆囊疾病;
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