The Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Can J Surg. 2012 Oct;55(5):307-11. doi: 10.1503/cjs.000411.
Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences.
We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gallbladder in the presence of complicating factors.
We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62).
Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.
超声刀已被建议作为腹腔镜胆囊切除术的一种替代方法，因为它产生的组织损伤较少，且胆囊穿孔的发生率可能更低。我们比较了这两种方法，以确定胆囊穿孔的发生率及其术中后果。
我们在 2008 年 7 月至 2009 年 12 月期间进行了一项前瞻性随机对照试验，涉及有症状的胆囊结石病且适合行腹腔镜胆囊切除术的成年患者。患者在给予麻醉前随机分为电切组或超声刀组。比较两组在解剖过程中胆囊穿孔、胆汁泄漏、结石溢出、镜头清洗、手术时间以及在存在合并症的情况下估计胆囊风险的发生率。
我们的研究纳入了 60 例成年患者。两组在人口统计学特征、症状、合并症、既往腹部手术、术前超声检查结果和术中并发症方面具有可比性。胆囊穿孔的总发生率为 28.3%（电切组为 40.0%，超声刀组为 16.7%，p=0.045）。电切组有 40.0%的患者发生胆汁泄漏，而超声刀组有 16.7%的患者发生胆汁泄漏（p=0.045）。电切组的镜头清洗时间（p=0.015）和手术时间（p=0.001）长于超声刀组。两组间结石溢出无统计学差异（p=0.62）。
超声刀安全有效，通过降低胆囊穿孔的发生率，改善了腹腔镜胆囊切除术的手术过程。
