Lubna H, Masoom M R
Professor Dr Lubna Habib, Professor of Surgery, Hamdard College of Medicine & Dentistry, Hamdard University Hospital, Karachi, Pakistan; E-mail: lubnahabib98@ gmail.com.
Mymensingh Med J. 2015 Jul;24(3):592-5.
This Quasi-experimental study was done to assess the effectiveness of hydro-dissection in difficult laparoscopic cholecystectomies in Hamdard University Hospital, Karachi, Pakistan, from April 2012 to March 2014. All consecutive patients who presented with cholelithiasis and planned for laparoscopic cholecystectomy were enrolled in this study. Per-operatively the degree of difficulty of the operation was assessed by Cuschieri's scale after grading; Grade II, III and IV cholecystectomies were included in this study. Hydro dissection with saline jet through 5mm simple irrigation and suction probe was used, Operative findings and the total number of patients, in whom anatomy of calot's triangle was clearly displayed with hydro-dissection, was recorded. A total 55 patients were included in the study after assessing the degree of difficulty per operatively by Cuschieri Scale. Thirty one (31) patients were in Group II, 22 in Group III and 02 were included in group IV of Cuschieri scale in which hydro-dissection was used. This method cleared the obscure anatomy in all patients in Group II but in 3 patients of Group III, dense adhesions required sharp dissection to clear the operative field. Two patients, in whom conversion was required, were grouped in Cuschieri's scale IV. Methods of dissection in difficult cholecystectomies are of paramount importance to avoid iatrogenic injuries. Hydro-dissection using suction irrigation probe is a safe and effective technique to clear the difficult anatomy.
本准实验性研究旨在评估2012年4月至2014年3月在巴基斯坦卡拉奇哈姆达德大学医院对困难腹腔镜胆囊切除术采用水分离法的有效性。所有连续出现胆石症并计划进行腹腔镜胆囊切除术的患者均纳入本研究。术中在分级后通过库希耶里量表评估手术难度；本研究纳入II级、III级和IV级胆囊切除术。使用通过5毫米简单冲洗吸引探头的盐水喷射进行水分离，记录手术结果以及通过水分离清晰显示胆囊三角解剖结构的患者总数。通过库希耶里量表评估术中难度后，共有55例患者纳入本研究。其中31例患者属于II组，22例属于III组，2例属于使用水分离法的库希耶里量表IV组。该方法使II组所有患者的模糊解剖结构变得清晰，但III组有3例患者存在致密粘连，需要锐性分离以清理手术视野。有2例患者需要中转手术，被归入库希耶里量表IV组。在困难胆囊切除术中，解剖方法对于避免医源性损伤至关重要。使用冲洗吸引探头进行水分离是一种清理困难解剖结构的安全有效技术。
