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腹腔镜胆囊切除术后二期手术:40例回顾性研究

Laparoscopic completion cholecystectomy: a retrospective study of 40 cases.

作者信息

Parmar Amit Kumar, Khandelwal Radha Govind, Mathew Mittu John, Reddy Prasanna Kumar

机构信息

Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, India.

出版信息

Asian J Endosc Surg. 2013 May;6(2):96-9. doi: 10.1111/ases.12012. Epub 2012 Dec 21.

Abstract

INTRODUCTION

Throughout the world, laparoscopic cholecystectomy is a widely accepted surgical treatment for both acute and chronic cholecystitis. It provides total relief of pre-surgical symptoms in up to 85% of patients. However, about 5% of patients may experience severe episodes of upper abdominal pain similar to those that they had prior to cholecystectomy; this is known as post-cholecystectomy syndrome. Gallbladder remnant with calculi is one of the causative factors. However, there have been only a few case series related to this reported in literature to date. Herein, we present our experience with laparoscopic management of gallbladder remnant with calculi in 40 cases.

METHODS

A retrospective study of 40 cases was carried out in our institution. All patients underwent open cholecystectomy at other centres, and their cases were managed by laparoscopic completion cholecystectomy.

RESULTS

The mean operating time was 102.4 min (range, 60-120 min). The duration of hospital stay was 2-4 days. Two cases were converted to open surgery because of extensive dense adhesions. One case had minor a common bile duct injury, and another had port-site infection. There were no cases of mortality.

CONCLUSION

Gallbladder remnant containing stones may be the cause of otherwise unexplained postcholecystectomy pain. Completion cholecystectomy offers a definitive treatment for any residual gallbladder remnant and can be performed laparoscopically.

摘要

引言

在全球范围内,腹腔镜胆囊切除术是治疗急慢性胆囊炎广泛接受的外科手术方法。它能使高达85%的患者术前症状完全缓解。然而,约5%的患者可能会经历类似于胆囊切除术前的严重上腹部疼痛发作;这被称为胆囊切除术后综合征。胆囊残余伴结石是致病因素之一。然而,迄今为止,文献中仅有少数关于此的病例系列报道。在此,我们介绍我们对40例胆囊残余伴结石患者进行腹腔镜处理的经验。

方法

我们机构对40例患者进行了回顾性研究。所有患者均在其他中心接受了开腹胆囊切除术,其病例通过腹腔镜完成胆囊切除术进行处理。

结果

平均手术时间为102.4分钟(范围60 - 120分钟)。住院时间为2 - 4天。2例因广泛致密粘连转为开腹手术。1例发生轻微胆总管损伤,另1例发生穿刺孔感染。无死亡病例。

结论

含有结石的胆囊残余可能是胆囊切除术后出现不明原因疼痛的原因。完成胆囊切除术为任何残留的胆囊残余提供了确定性治疗,且可通过腹腔镜进行。

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