Abstract:

Cholecystectomy：Changes in technology and ideas to enlighten to us        Lau WY, Lai ECH, Lau SHY. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, P.R. China
Corresponding author：Lau WY，E-mail：josephlau@cuhk.edu.hk
Abstract    As laparoscopic cholecystectomy offers advantages over open cholecystectomy，it has now replaced open cholecystectomy to become the gold standard in the treatment of symptomatic gallstone diseases. Many techniques in laparoscopic cholecystectomy have evolved to improve postoperative outcomes and cosmesis. These modifications include a reduction in port size and/or number. However，any modification in the conventional technique should not compromise safety of the operation and iatrogenic bile duct injury is the main concern. In addition to prevention，early identification and appropriate treatment are critical in improving the outcomes of bile duct injuries. Appropriate patient selection， proper training and adequate experienced surgeons are important in carrying out a safe cholecystectomy.

Key words: laparoscopic cholecystectomy；open cholecystectomy, iatrogenic injury

摘要：

腹腔镜胆囊切除术已成为胆囊切除的标准术式，与开腹胆囊切除术相比，具有创伤小、疼痛轻、术后恢复快、瘢痕小、住院时间短等优点。在过去的30年中，腹腔镜胆囊切除术前期发展主要在于完善技术，提高安全性，后期发展则更注重微创，追求更小长度、更少数目的外科切口。然而，新技术的引入不应影响手术的安全性。医源性胆管损伤是手术安全方面最主要关注的问题。胆管损伤重在预防，一旦发生，早期识别和适当治疗对改善病人胆管损伤结局至关重要。因此，病人的适当选择、腹腔镜胆囊切除术的技术培训和足够的手术经验仍是保证胆囊切除手术安全性的重要因素。

关键词: 腹腔镜胆囊切除术, 开腹胆囊切除术, 医源性损伤