Honda Goro, Iwanaga Tomohiro, Kurata Masanao, Watanabe Fumiaki, Satoh Hiroki, Iwasaki Ken-ichi
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(4):445-9. doi: 10.1007/s00534-009-0060-3. Epub 2009 Mar 4.
During laparoscopic cholecystectomy (LC), misidentification of the cystic duct, which causes major bile duct injuries, can result from wrong or incomplete dissection of Calot's triangle. Therefore, the critical view of safety has been accepted as a safe method for gaining a sufficient view of Calot's triangle before transecting the cystic duct. However, even in cases without aberrant anatomy of the bile duct, bile duct injury can occur by a wrong approach to a critical view of safety. Additionally, in cases of badly inflamed gallbladders, it is often hard to achieve a critical view of safety, because Calot's triangle is often solid and cannot be expanded. In our standardized procedure, which is based on exposing the inner layer of the subserosal layer (the ss-i layer), the critical view of safety can be safely achieved. We have safely performed LC, using our standardized procedure, for many cases with cholecystitis with highly inflamed gallbladders. In this article, focusing especially on prevention of bile duct injuries, we present our standardized procedure to achieve the critical view of safety along with histological findings.
在腹腔镜胆囊切除术（LC）中，胆囊管误认会导致主要胆管损伤，这可能源于对胆囊三角的错误或不完整解剖。因此，安全关键视野已被视为在横断胆囊管前充分观察胆囊三角的一种安全方法。然而，即使在胆管无解剖变异的情况下，错误的安全关键视野操作方法也可能导致胆管损伤。此外，在胆囊严重发炎的病例中，往往难以获得安全关键视野，因为胆囊三角通常质地坚硬且无法展开。在我们基于暴露浆膜下层内层（ss-i层）的标准化操作中，可以安全地实现安全关键视野。我们已使用标准化操作，为许多患有高度发炎胆囊的胆囊炎病例安全地实施了LC。在本文中，我们特别关注胆管损伤的预防，介绍我们实现安全关键视野的标准化操作以及组织学发现。
