Giger U, Michel J M, Vonlanthen R, Becker K, Kocher T, Krähenbühl L
Department of Surgery, Hôpital Cantonal Fribourg, 1700, Fribourg, Switzerland.
Langenbecks Arch Surg. 2005 Sep;390(5):373-80. doi: 10.1007/s00423-004-0509-4. Epub 2004 Aug 14.
Laparoscopic cholecystectomy (LC) has become the treatment of choice for symptomatic cholelithiasis. However, the laparoscopic approach has remained controversial for patients with acute cholecystitis (AC) because of technical difficulties that, compared with open cholecystectomy (OC), might lead to higher complication rates, particularly common bile duct (CBD) injuries and infection.
We reviewed recent clinical findings on feasibility, safety and potential benefits of LC in patients with AC. An electronic search using the PubMed and MEDLINE databases was performed using the terms laparoscopic cholecystectomy, open cholecystectomy and acute cholecystitis. Pertinent references from articles and books not identified by the search engines were also retrieved. Relevant surgical textbooks were also reviewed.
The early laparoscopic approach has been shown to be technically feasible and at least equally as safe as the open approach. However, extensive inflammation, adhesions and consequent increased oozing can make laparoscopic dissection of Calot's triangle and recognition of the biliary anatomy hazardous and difficult. Therefore, conversion to OC remains an important treatment option to secure patient safety in such difficult conditions. The question of whether intraoperative cholangiography (IOC) should be used routinely or only selectively has never been resolved. Proponents for each side have put forward compelling arguments.
腹腔镜胆囊切除术（LC）已成为有症状胆结石的首选治疗方法。然而，由于技术困难，与开腹胆囊切除术（OC）相比，腹腔镜手术对于急性胆囊炎（AC）患者仍存在争议，可能导致更高的并发症发生率，尤其是胆总管（CBD）损伤和感染。
我们回顾了近期关于LC治疗AC患者的可行性、安全性及潜在益处的临床研究结果。使用PubMed和MEDLINE数据库进行电子检索，检索词为腹腔镜胆囊切除术、开腹胆囊切除术和急性胆囊炎。还检索了搜索引擎未识别的文章和书籍中的相关参考文献。同时查阅了相关外科教科书。
早期腹腔镜手术已被证明在技术上可行，且至少与开腹手术一样安全。然而，广泛的炎症、粘连以及随之而来的渗血增加，会使腹腔镜下解剖Calot三角和识别胆道解剖结构变得危险且困难。因此，在这种困难情况下，转为开腹手术仍是确保患者安全的重要治疗选择。术中胆管造影（IOC）是应常规使用还是仅选择性使用的问题从未得到解决。双方支持者都提出了令人信服的论据。
