Department of Surgery, Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College, 525 East 68th Street, Room F763, Box 294, New York, NY 10065, USA.
Surg Endosc. 2011 May;25(5):1683-8. doi: 10.1007/s00464-010-1408-0. Epub 2010 Oct 29.
While laparoscopy is now the standard for cholecystectomy, recent papers have focused on single-incision approaches. Intraoperative cholangiography remains an integral part of laparoscopic cholecystectomy but has not yet been well described within the single-access literature. We discuss our method of single-incision laparoscopic cholecystectomy with routine intraoperative cholangiograms.
A retrospective review of our surgical database was completed. One hundred twenty-three patients undergoing laparoscopic cholecystectomy were identified (83 standard laparoscopy, 40 single-incision laparoscopy). Patient demographics including age and body mass index (BMI), and indications for surgery, operative time, intra- and postoperative complications, and ability to complete cholangiography were analyzed.
All patients with standard laparoscopy had successful cholangiograms. Two patients did not undergo cholangiography based on a preoperative decision (pregnancy). In the 40 patients who underwent single-incision cholecystectomy, 38 cholangiograms were completed (95%). One patient with acute cholecystitis had a small cystic duct which could not be cannulated. The second had a cystic duct through which the cholangiocatheter could not be advanced. Comparative analysis of patient demographics showed a significant difference in patient age between the two groups, as well as a significantly greater number of patients undergoing single-incision cholecystectomy for symptomatic cholelithiasis as opposed to acute cholecystitis.
Completion of intraoperative cholangiography is an important aspect of cholecystectomy in order to identify choledocholithiasis and verify anatomy. With the advent of single-access laparoscopy, standard operative principles should not be compromised. Cholangiography may provide a safer approach to cholecystectomy when adopting a new technique. We present our technique of single-incision cholecystectomy and routine cholangiography with a 95% success rate. The ability to perform single-incision intraoperative cholangiograms will allow a safe, more minimally invasive approach to cholecystectomy with suspected choledocholithiasis and obviate the need to convert to standard multiport laparoscopy for the sole reason of completing cholangiograms.
虽然腹腔镜现在是胆囊切除术的标准方法，但最近的论文侧重于单切口方法。术中胆管造影仍然是腹腔镜胆囊切除术的一个组成部分，但在单通道文献中尚未得到很好的描述。我们讨论了我们的常规术中胆管造影单切口腹腔镜胆囊切除术的方法。
对我们的手术数据库进行了回顾性分析。确定了 123 例接受腹腔镜胆囊切除术的患者（83 例标准腹腔镜，40 例单切口腹腔镜）。分析了患者的人口统计学特征，包括年龄和体重指数（BMI），以及手术适应证、手术时间、围手术期并发症，以及完成胆管造影的能力。
所有接受标准腹腔镜检查的患者均成功进行了胆管造影。有 2 例患者由于术前决定（怀孕）而未进行胆管造影。在 40 例接受单切口胆囊切除术的患者中，完成了 38 例胆管造影（95%）。1 例急性胆囊炎患者的胆囊管较小，无法插管。第二位患者的胆囊管无法推进胆管造影导管。对患者人口统计学数据的比较分析显示，两组患者的年龄存在显著差异，且接受单切口胆囊切除术的患者中，有症状性胆石症的患者明显多于急性胆囊炎患者。
完成术中胆管造影是胆囊切除术的一个重要方面，以便识别胆总管结石并验证解剖结构。随着单通道腹腔镜技术的出现，标准手术原则不应受到影响。在采用新技术时，胆管造影可能为胆囊切除术提供更安全的方法。我们提出了我们的单切口胆囊切除术和常规胆管造影技术，成功率为 95%。能够进行单切口术中胆管造影，可以安全地采用更微创的方法进行胆囊切除术，并避免仅因完成胆管造影而需要转换为标准多孔腹腔镜。
