Hannan Md Jafrul, Hoque Md Mozammel
Department of Pediatric Surgery, Chattagram Maa-Shishu O General Hospital, Agrabad, Chittagong, Bangladesh.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):983-6. doi: 10.1089/lap.2011.0214. Epub 2011 Nov 2.
Although laparoscopy has now become the procedure of choice for removal of gallbladder, complications especially injury to cystic artery and ducts are thought to be higher. We describe a technique that avoids handling and injury of cystic artery and resultant duct injuries. The video length is 2 minutes 13 seconds.
From October 7, 2005, to December 31, 2010, 17 patients were successfully operated by the cystic artery sparing technique. In this technique, dissection begins distal to cystic lymph node on the gallbladder wall using hook cautery, thereby clears the Calot's triangle without even touching the cystic artery. This maneuver eliminates the risk of injuring thus causing bleeding and any subsequent complications. Age, sex, and operative outcomes including follow-ups were evaluated.
Age of the patients ranged from 3.4 years to 16 years with an average of 10.12 years. Males were predominant (10:7). Average operative time was 40 minutes. There were no intraoperative or immediate postoperative complications. Patients were allowed feeding 4-6 hours after operation and discharged the following morning. Patients were asked to come for follow-up at 1 week, 1 month, 3 months, 6 months, and 1 year and thereafter yearly. Follow-up period ranged from 6 months to 5 years. There were no operation-related complications other than minor abdominal pain in 3 patients and port-site pain in 2 patients which resolved on conservative treatments.
During laparoscopic cholecystectomy, if handling of the main cystic artery is avoided then complications of hemorrhage and bile duct injuries can be minimized.
尽管腹腔镜检查现已成为胆囊切除术的首选方法，但人们认为并发症尤其是胆囊动脉和胆管损伤的发生率较高。我们描述了一种避免处理和损伤胆囊动脉以及由此导致的胆管损伤的技术。视频时长为2分13秒。
从2005年10月7日至2010年12月31日，17例患者通过保留胆囊动脉技术成功进行了手术。在该技术中，使用钩形电灼器在胆囊壁上的胆囊淋巴结远端开始解剖，从而在不触及胆囊动脉的情况下清理胆囊三角。这种操作消除了损伤从而导致出血及任何后续并发症的风险。对患者的年龄、性别以及包括随访在内的手术结果进行了评估。
患者年龄范围为3.4岁至16岁，平均年龄为10.12岁。男性居多（10例：7例）。平均手术时间为40分钟。术中及术后即刻均无并发症。患者术后4 - 6小时可进食，并于次日早晨出院。要求患者在术后1周、1个月、3个月、6个月、1年前来随访，此后每年随访一次。随访期为6个月至5年。除3例患者出现轻微腹痛和2例患者出现穿刺孔部位疼痛经保守治疗后缓解外，无其他与手术相关的并发症。
在腹腔镜胆囊切除术中，如果避免处理主要胆囊动脉，那么出血和胆管损伤的并发症可降至最低。
