Lee Kuo-Ting, Shan Yan-Shen, Wang Shin-Tai, Lin Ping-Wen
Department of Surgery, National Cheng Kung University Hospital, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan 70428, Taiwan, ROC.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1388-92.
BACKGROUND/AIMS: Grasping a thick and distended gallbladder is one of the most common technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. This prospective study was conducted to investigate the use of the Verres needle decompression method to facilitate laparoscopic cholecystectomy in acute cholecystitis.
Between April 1998 and April 2002, patients with acute cholecystitis scheduled to receive laparoscopic cholecystectomy emergently were included. A Verres needle was applied through the subcostal area to decompress the acute inflamed distended gallbladder after establishing pneumoperitoneum.
In total 54 patients, 30 male and 24 female with mean age 53.50 years (range 21-80), consented to the operation. Laparoscopic cholecystectomy was performed successfully in 44 patients. The conversion of laparoscopic cholecystectomy to open surgery was needed in 10 patients (conversion rate: 18.5%). The failure to identify the triangle of Calot is the only risk factor associated with conversion. The more severe acute cholecystitis is, the higher the conversion rate is (11.5% in uncomplicated cholecystitis, 31.6% in complicated cholecystitis). No bile duct injury was noted. Postoperative morbidity happened in three cases: two port-site discharge and one subphrenic abscess. No mortality occurred.
Verres needle decompression of the acute inflamed gallbladder did facilitate laparoscopic cholecystectomy in acute cholecystitis with low conversion rate.
背景/目的：在急性胆囊炎的腹腔镜胆囊切除术中，抓取增厚且扩张的胆囊是最常见的技术难题之一。本前瞻性研究旨在探讨使用Verres针减压法辅助急性胆囊炎的腹腔镜胆囊切除术。
纳入1998年4月至2002年4月期间计划紧急行腹腔镜胆囊切除术的急性胆囊炎患者。在建立气腹后，通过肋下区域应用Verres针对急性炎症扩张的胆囊进行减压。
共有54例患者，男性30例，女性24例，平均年龄53.50岁（范围21 - 80岁），同意接受手术。44例患者成功进行了腹腔镜胆囊切除术。10例患者需要将腹腔镜胆囊切除术转为开腹手术（转化率：18.5%）。无法识别Calot三角是与转为开腹手术相关的唯一危险因素。急性胆囊炎越严重，转化率越高（单纯性胆囊炎为11.5%，复杂性胆囊炎为31.6%）。未发现胆管损伤。术后有3例发生并发症：2例切口感染，1例膈下脓肿。无死亡病例。
Verres针减压急性炎症胆囊确实有助于急性胆囊炎的腹腔镜胆囊切除术，且转化率低。
