Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Hospital, 1-1, Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
Surg Today. 2013 Mar;43(3):313-6. doi: 10.1007/s00595-012-0241-6. Epub 2012 Jul 4.
It is not uncommon for cardiac surgery to be complicated by postoperative acute cholecystitis. We recently performed laparoscopic cholecystectomy for severe acute cholecystitis, which developed after the implantation of a left ventricular assist device (LVAD) for dilated cardiomyopathy in a 31-year-old man. The LVAD is an accepted bridging treatment to heart transplantation. With the patient under general anesthesia, we made landmarks around the LVAD and a drive-line to prevent injury by trocar insertion. The first port was inserted in the umbilicus and because the subxyphoid space was occupied, the second trocar was inserted in the left flank and the other two trocars were inserted in the right subcostal area. The operation time was 160 min and the estimated blood loss was 430 ml. The patient had an uneventful postoperative course. Thus, concomitant cholecystectomy should be considered when installing an LVAD system if the patient has biliary abnormalities.
心脏手术后并发术后急性胆囊炎并不少见。我们最近为一名 31 岁男性因扩张型心肌病植入左心室辅助装置（LVAD）后发生严重急性胆囊炎行腹腔镜胆囊切除术。LVAD 是心脏移植的一种公认的桥接治疗方法。在全身麻醉下，我们在 LVAD 周围和驱动线上做了标记，以防止套管插入时受伤。第一个端口插入脐部，由于剑突下空间被占用，第二个套管插入左肋部，另外两个套管插入右肋缘下区域。手术时间为 160 分钟，估计失血量为 430 毫升。患者术后恢复顺利。因此，如果患者有胆道异常，在安装 LVAD 系统时应考虑同时行胆囊切除术。
