Kuwabara Jun, Watanabe Yuji, Kameoka Kazuhiro, Horiuchi Atsushi, Sato Kouichi, Yukumi Shungo, Yoshida Motohira, Yamamoto Yuji, Sugishita Hiroki
Second Department of Surgery, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan,
Surg Today. 2014 Mar;44(3):462-5. doi: 10.1007/s00595-013-0626-1. Epub 2013 Jun 5.
Cholecystectomy can become hazardous when inflammation develops, leading to anatomical changes in Calot's triangle. We attempted to study the safety and efficacy of laparoscopic subtotal cholecystectomy (LSC) to decrease the incidence of complications and the rate of conversion to open surgery.
Patients who underwent LSC between January 2005 and December 2008 were evaluated retrospectively. The operations were performed laparoscopically irrespective of the grade of inflammation estimated preoperatively. However, patients with severe inflammation of the gallbladder underwent LSC involving resection of the anterior wall of the gallbladder, removal of all stones and placement of an infrahepatic drainage tube. To prevent intraoperative complications, including bile duct injury, intraoperative cholangiography was performed.
LSC was performed in 26 elective procedures among 26 patients (eight females, 18 males). The median patient age was 69 years (range 43-82 years). The median operative time was 125 min (range 60-215 min) and the median postoperative inpatient stay was 6 days (range 3-21 days). Cholangiography was performed during surgery in 24 patients. One patient underwent postoperative endoscopic sphincterotomy for a retained common bile duct stone that was found on cholangiography during surgery. Neither complications nor conversion to open surgery were encountered in this study.
LSC with the aid of intraoperative cholangiography is a safe and effective treatment for severe cholecystitis.
当炎症发展导致胆囊三角解剖结构改变时，胆囊切除术可能变得危险。我们试图研究腹腔镜次全胆囊切除术（LSC）的安全性和有效性，以降低并发症发生率和中转开腹手术率。
回顾性评估2005年1月至2008年12月期间接受LSC的患者。无论术前估计的炎症程度如何，均通过腹腔镜进行手术。然而，胆囊严重炎症的患者接受LSC，包括切除胆囊前壁、取出所有结石并放置肝下引流管。为预防术中并发症，包括胆管损伤，术中进行了胆管造影。
26例患者（8例女性，18例男性）接受了26例择期LSC手术。患者年龄中位数为69岁（范围43 - 82岁）。手术时间中位数为125分钟（范围60 - 215分钟），术后住院时间中位数为6天（范围3 - 21天）。24例患者在手术期间进行了胆管造影。1例患者因手术中胆管造影发现胆总管残留结石，术后接受了内镜括约肌切开术。本研究中未遇到并发症或中转开腹手术的情况。
借助术中胆管造影的LSC是治疗严重胆囊炎的一种安全有效的方法。
