Davis Brian, Castaneda Gino, Lopez Jose
Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, El Paso, Texas 79905, USA.
Am Surg. 2012 Jul;78(7):814-7.
Complicated cholecystitis can make dissections around the triangle of Calot difficult with a higher risk of duct and arterial injury. We reviewed a series of patients with cholecystitis receiving either partial or subtotal cholecystectomies and compared it with total cholecystectomies with respect to complications. A retrospective chart review was performed on all subtotal cholecystectomies performed for cholecystitis at University Medical Center of El Paso from June 2004 to December 2010. A similar number of patients who had total cholecystectomies for cholecystitis were selected as a comparison group from that same time period. A total of 116 patients who had subtotal and total cholecystectomies were reviewed (58 patients in each group). There were seven postoperative complications noted in the subtotal cholecystecomy (SC) group versus 14 for the total cholecystectomy (TC) group. Three patients in the SC group had cystic duct leaks, all successfully treated by endoscopic retrograde cholangiopancreatography with biliary stenting. There were two patients who had common bile duct injuries in the TC group and none in the SC group. Two patients had duodenal injuries in the TC group. Subtotal cholecystectomy is a viable alternative to total cholecystectomy in cases of complicated cholecystitis.
复杂性胆囊炎会使在胆囊三角周围的解剖操作变得困难，胆管和动脉损伤风险更高。我们回顾了一系列接受部分或次全胆囊切除术的胆囊炎患者，并将其与接受全胆囊切除术的患者在并发症方面进行了比较。对2004年6月至2010年12月在埃尔帕索大学医学中心因胆囊炎进行的所有次全胆囊切除术进行了回顾性图表审查。从同一时期选择了数量相似的因胆囊炎接受全胆囊切除术的患者作为对照组。总共对116例行次全和全胆囊切除术的患者进行了审查（每组58例）。次全胆囊切除术（SC）组有7例术后并发症，而全胆囊切除术（TC）组有14例。SC组有3例患者出现胆囊管漏，均通过内镜逆行胰胆管造影术加胆道支架置入成功治疗。TC组有2例患者出现胆总管损伤，SC组无。TC组有2例患者出现十二指肠损伤。在复杂性胆囊炎病例中，次全胆囊切除术是全胆囊切除术的一种可行替代方案。
