经胆囊管无气腹胆囊切除术治疗胆囊结石、胆囊炎和胆总管结石。

Transcylindrical gas-free cholecystectomy for the treatment of cholelithiasis, cholecystitis, and choledocholithiasis.

机构信息

Department of Surgery, Hospital Siberia-Serena, Talarrubias, Badajoz, Spain.

出版信息

Surg Endosc. 2010 Sep;24(9):2099-104. doi: 10.1007/s00464-010-0904-6. Epub 2010 Mar 31.

DOI:10.1007/s00464-010-0904-6

PMID:20354871

Abstract

BACKGROUND

Laparoscopic cholecystectomy (LC) has become the standard for treatment of uncomplicated cholecystolithiasis. However, in cases of cholecystitis or cholecysto-choledocholithiasis, technical and skill requirements may make questionable the convenience of laparoscopy. Transcylindrical cholecystectomy (TC) is a modified minilaparotomy, performed gas-free through a single cylinder 3.8 cm in diameter and 10.0 cm in length. Our study objective has been to assess the efficacy and potential advantages of TC in the treatment of cholelithiasis, cholecystitis, and cholecholithiasis through an efficacy, prospective, and longitudinal study.

METHOD

TC was carried out in 364 consecutive patients including 78 acute cholecystitis, 37 acute biliary pancreatitis, and 48 suspected choledocholithiasis. Transcystic cholangiography was selectively attempted in 74 patients (20.3%) and successfully obtained in all but one patient. Twenty-six patients (7.1%) underwent transcylindrical common duct exploration (and calculi removal) through a choledochotomy.

RESULTS

Operation was converted into subcostal laparotomy in other 23 patients (5.9%). In our series, there were no injuries to the main bile ducts or hemorrhagic accidents. Operating times in minutes (SD) were (i) "simple cholecystectomy" without cholangiography n = 237: 43.5 (13.3), with cholangiography n = 30: 64.2 (20.7), (ii) "cholecystitis" n = 78: 66.2 (28.7), and (iii) "choledocholithiasis" n = 26: 117.0 (24.6). Postoperative complications for the respective patients in groups i, ii, and iii were (a) wound infection: 5 (1.9%), 0 and 0; (b) bile leaks: 2 (0.75%; one causing death), 2 (0.75%) and 0; (c) reoperation for bleeding: 1 (0.4%), 0 and 1 (3.8%); and (d) residual stones in the main bile ducts: 0, 0 and 1 (3.8%).

CONCLUSION

TC has been proved to be applicable, efficient, and safe for the treatment of cholelithiasis and its complications.

摘要

背景

腹腔镜胆囊切除术（LC）已成为治疗单纯性胆囊结石的标准方法。然而，在胆囊炎或胆囊胆管结石的情况下，技术和技能要求可能会使腹腔镜手术的便利性受到质疑。经圆柱型胆囊切除术（TC）是一种改良的小切口手术，通过一个直径 3.8 厘米、长 10.0 厘米的圆柱型器械在无气腹状态下进行。我们的研究目的是通过一项疗效、前瞻性和纵向研究来评估 TC 在治疗胆石症、胆囊炎和胆管结石方面的疗效和潜在优势。

方法

TC 在 364 例连续患者中进行，包括 78 例急性胆囊炎、37 例急性胆源性胰腺炎和 48 例疑似胆总管结石。选择性对 74 例患者（20.3%）进行经胆囊管胆管造影术，并成功获得除 1 例患者外的所有患者的结果。26 例患者（7.1%）通过胆总管切开术进行经圆柱型胆总管探查（并取出结石）。

结果

在其他 23 例患者（5.9%）中转开腹手术。在本系列中，没有发生主胆管损伤或出血性事故。手术时间以分钟（SD）表示：（i）“单纯胆囊切除术”，无胆管造影术 n = 237：43.5（13.3），有胆管造影术 n = 30：64.2（20.7），（ii）“胆囊炎”n = 78：66.2（28.7），和（iii）“胆总管结石”n = 26：117.0（24.6）。各组患者术后并发症分别为（a）伤口感染：5 例（1.9%），0 例和 0 例；（b）胆漏：2 例（0.75%，1 例死亡），2 例和 0 例；（c）再次出血手术：1 例（0.4%），0 例和 1 例（3.8%）；和（d）主胆管残留结石：0 例，0 例和 1 例（3.8%）。