探讨日间腹腔镜胆囊切除术（LC/DS）的安全性和经济效益。

回顾性分析2009年11月至2017年1月在中国人民解放军总医院5 771例行LC/DS及2 450例行常规腹腔镜胆囊切除术（CLC）患者临床资料。患者均签署知情同意书，符合医学伦理规定。LC/DS组患者男2 204例，女3 567例；平均年龄（51±13）岁；接受LC/DS手术模式。CLC组患者男992例，女1 458例；年龄（51±13）岁。两组住院时间、医疗总费用比较采用Mann-Whitney检验，中转开腹率、术后并发症、术后24 h出院率、30 d再入院率的比较采用χ²检验。

LC/DS组患者中转开腹率、30 d再入院率分别为0.36%、0.49%，CLC组相应为0.16%、0.49%，差异无统计学意义（χ²=2.83，0.00；P>0.05）。LC/DS组患者术后24 h出院率83.34%，明显高于CLC组的49.22%（χ²=1 020.30，P<0.05）；而术后并发症发生率6.59%，明显低于CLC组的14.56%（χ²=130.19，P<0.05）。LC/DS组患者住院时间、医疗总费用分别为[3.0（1.0～33.0）] d、[0.98（0.56～4.59）]万元，明显低于CLC组的[5.0（1.0～36.0）] d、[1.40（0.38～2.95）]万元（Z=-17.33，-45.40；P<0.05）。

LC/DS是安全和有效的，可以减少患者术后并发症发生率，缩短患者住院时间，降低医疗费用。

To explore the safety and economic benefits of day surgery laparoscopic cholecystectomy (LC/DS).

Clinical data of 5 771 patients undergoing LC/DS and 2 450 undergoing conventional laparoscopic cholecystectomy (CLC) in PLA General Hospital from November 2009 to January 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. In LC/DS group, there were 2 204 males and 3 567 females with the average age of (51±13) years old. In CLC group, there were 992 males and 1 458 females with the average age of (51±13) years old. The hospitalization time and total medical expenses of two groups were compared by Mann-Whitney test. The ratio of conversion to laparotomy, postoperative complication, postoperative 24-hour discharge rate, and 30-day readmission rate were compared by Chi-square test.

The ratio of conversion to laparotomy and 30-day readmission rate was respectively 0.36%, 0.49% in LC/DS group and 0.16%, 0.49% in CLC group, and no significant difference were observed (χ²=2.83, 0.00; P>0.05). The postoperative 24-hour discharge rate in LC/DS Group was 83.34%, significantly higher than 49.22% in CLC group (χ²=1 020.30, P<0.05). The postoperative complication rate in LC/DS group was 6.59%, significantly lower than 14.56% in CLC group (χ²=130.19, P<0.05). The hospitalization time and total medical expenses in LC/DS group was respectively [3.0(1.0-33.0)] d and [0.98(0.56-4.59)] million RMB, significantly lower than [5.0(1.0-36.0)] d and [1.40(0.38-2.95)] million RMB in CLC group (Z=-17.33,-45.40; P<0.05).

LC/DS is safe and effective. It can reduce the incidence of postoperative complications, shorten the hospitalization time and reduce the hospitalization cost of patients.