Shulutko Alexander M, Kazaryan Airazat M, Agadzhanov Vadim G
Department of Faculty Surgery N 2, I.M. Sechenov Moscow Medical Academy, Moscow, Russia.
Int J Surg. 2007 Dec;5(6):423-8. doi: 10.1016/j.ijsu.2007.07.004. Epub 2007 Jul 26.
The last decades have been characterized by a rapid growth in minimally invasive techniques for acute and chronic cholecystitis. The aim of our study was to analyze 10 years of experience with the mini-laparotomy cholecystectomy.
From 1994 to 2004, we performed 2295 mini-laparotomy cholecystectomies, including 1028 patients with acute and 1267 patients with chronic cholecystitis. There were 1780 women and 515 men. We utilized a special surgical tool kit with a system of circular and small hook-retractors incorporating an illuminator and long surgical instruments. Our surgical approach was carried out using a 3-5 cm longitudinal incision located immediately above the gallbladder with a muscle splitting technique.
The mean time of operation was 64.5+/-24.5 min and the conversion rate was 3.7%. Intraoperative complications occurred in 25 cases (1.1%), including 4 cases (0.17%) of biliary tract injury. Cholecystectomy was combined with intervention on the choledochus and the papilla of Vater in 133 patients with choledocholithiasis. Postoperative complications developed in 4.1%. Five hundred and five patients (22%) required opioid analgesics on the first postoperative day. The mortality rate was 0.17%. The mortalities involved patients who had severe concomitant diseases and required urgent surgery for acute cholecystitis. Patients operated for acute cholecystitis had significantly higher rates of postoperative complications (5.8% vs. 2.8%), need for opioids (25.5% vs. 19.2%) and mortality (0.39% vs. 0%).
Mini-laparotomy cholecystectomy is an alternative to laparoscopic approach in the surgical treatment of acute and chronic cholecystitis.
在过去几十年中，急性和慢性胆囊炎的微创技术迅速发展。我们研究的目的是分析小切口开腹胆囊切除术10年的经验。
1994年至2004年，我们共进行了2295例小切口开腹胆囊切除术，其中急性胆囊炎患者1028例，慢性胆囊炎患者1267例。患者中女性1780例，男性515例。我们使用了一种特殊的手术工具包，该工具包带有一个圆形和小型钩状牵开器系统，其中包含一个照明器和长手术器械。我们的手术方法是采用肌肉劈开技术，在胆囊正上方做一个3 - 5厘米的纵向切口。
平均手术时间为64.5±24.5分钟，中转率为3.7%。术中并发症发生25例（1.1%），包括4例（0.17%）胆道损伤。133例胆总管结石患者的胆囊切除术联合了胆总管和十二指肠乳头干预。术后并发症发生率为4.1%。505例（22%）患者术后第一天需要使用阿片类镇痛药。死亡率为0.17%。死亡患者均患有严重的合并症，因急性胆囊炎需要紧急手术。急性胆囊炎手术患者的术后并发症发生率（5.8%对2.8%）、阿片类药物需求率（25.5%对19.2%）和死亡率（0.39%对0%）显著更高。
在急性和慢性胆囊炎的外科治疗中，小切口开腹胆囊切除术是腹腔镜手术的一种替代方法。
