Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
Surg Today. 2009;39(10):870-5. doi: 10.1007/s00595-008-3975-4. Epub 2009 Sep 27.
To evaluate the efficacy and outcome of laparoscopic subtotal cholecystectomy (LSC) for patients with severe cholecystitis.
Between April 1992 and May 2008, 1226 patients underwent laparoscopic cholecystectomy (LC). From 2000 onward 60 patients with severe cholecystitis underwent LSC. The outcomes of LC were compared between patients who underwent the procedure between 1992 and 1999 (group A; n = 643) and those who underwent the procedure between 2000 and 2008 after the introduction of LSC (group B; n = 583), respectively. In Group B, operative outcomes were also compared between the LC and LSC groups.
The incidence of bile duct injury (1.6% vs 0.3%, P = 0.040) and conversion to open cholecystectomy (2.2% vs 0.3%, P = 0.046) was significantly lower in group B. The mean operative time was significantly longer (119.6 min vs 71.0 min., P < 0.001), and the mean blood loss was significantly higher (53.4 ml vs 12.9 ml, P < 0.001) in the LSC group. No significant differences were observed between LC and LSC in the incidence of postoperative morbidities or postoperative hospital stay. No patient had remnant gallstones or gallbladder cancers after a median follow-up of 42 months.
Laparoscopic subtotal cholecystectomy is safe and effective for preventing bile duct injuries and lowering the conversion rate in patients with technically difficult severe cholecystitis.
评估腹腔镜胆囊次全切除术（LSC）治疗重度胆囊炎患者的疗效和结果。
1992 年 4 月至 2008 年 5 月，1226 例患者接受了腹腔镜胆囊切除术（LC）。自 2000 年以来，60 例重度胆囊炎患者接受了 LSC。比较了 1992 年至 1999 年（A 组，n = 643）和 2000 年至 2008 年 LSC 引入后（B 组，n = 583）接受 LC 的患者的 LC 结果。在 B 组中，还比较了 LC 和 LSC 组之间的手术结果。
胆管损伤的发生率（1.6%比 0.3%，P = 0.040）和中转开腹胆囊切除术的发生率（2.2%比 0.3%，P = 0.046）明显降低。LSC 组的平均手术时间明显延长（119.6 分钟比 71.0 分钟，P < 0.001），平均出血量明显增加（53.4 毫升比 12.9 毫升，P < 0.001）。LC 和 LSC 在术后发病率或术后住院时间方面无显著差异。中位随访 42 个月后，无患者残留胆囊结石或胆囊癌。
腹腔镜胆囊次全切除术对于预防技术上困难的重度胆囊炎患者的胆管损伤和降低中转率是安全有效的。
