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在严重炎症情况下进行部分胆囊切除术是一个可接受的考虑方案,长期后遗症较少。

Partial cholecystectomy in the setting of severe inflammation is an acceptable consideration with few long-term sequelae.

作者信息

Sharp Collin F, Garza R Zachary, Mangram Alicia J, Dunn Ernest L

机构信息

Department of Medical Education, Methodist Dallas Medical Center, 1441 North Beckley Avenue, Dallas, TX 75203, USA.

出版信息

Am Surg. 2009 Mar;75(3):249-52.

Abstract

Open cholecystectomy is infrequently performed. For the general surgeon, open cholecystectomy is typically performed when a great degree of inflammation precludes safe laparoscopic removal. The degree of inflammation can also lead to an unacceptable risk of common bile duct injury during the dissection of the triangle of Calot. In this situation, the extent of dissection and amount of resection is not well established. We undertook a retrospective review and follow-up telephone questionnaire of all partial cholecystectomies performed. Partial cholecystectomy was performed in 26 cases with open, laparoscopic converted to open, and laparoscopic techniques. Postoperative complications occurred in seven (27%) patients with three (12%) experiencing more than one complication. There was a bile leak in three (12%), subhepatic abscess in three (12%), wound infection in two (8%), and retained common duct stone in one (4%). There were no common bile duct injuries and no deaths. Telephone interviews were conducted with 19 (73%) patients. Average length of follow up was 314 days. At the time of last contact, no ongoing complaints attributable to biliary pain were present. Our data suggest that partial cholecystectomy in the setting of severe inflammation is a reasonable operation with few long-term sequelae, good clinical results, and satisfactory symptom relief.

摘要

开腹胆囊切除术很少进行。对于普通外科医生来说,当炎症程度严重到无法安全地进行腹腔镜切除时,通常会进行开腹胆囊切除术。炎症程度也可能导致在解剖胆囊三角时胆总管损伤的风险不可接受。在这种情况下,解剖范围和切除量尚未明确。我们对所有进行的部分胆囊切除术进行了回顾性研究并通过电话问卷进行了随访。采用开放、腹腔镜中转开腹和腹腔镜技术进行了26例部分胆囊切除术。7例(27%)患者发生术后并发症,其中3例(12%)出现不止一种并发症。3例(12%)发生胆漏,3例(12%)发生肝下脓肿,2例(8%)发生伤口感染,1例(4%)发生胆总管结石残留。无胆总管损伤及死亡病例。对19例(73%)患者进行了电话随访。平均随访时间为314天。在最后一次联系时,没有因胆绞痛而持续存在的主诉。我们的数据表明,在严重炎症情况下进行部分胆囊切除术是一种合理的手术,长期后遗症少,临床效果良好,症状缓解满意。

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