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20只犬腹腔镜胆囊切除术的围手术期并发症及结果

Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs.

作者信息

Scott Jacqueline, Singh Ameet, Mayhew Philipp D, Brad Case J, Runge Jeffrey J, Gatineau Matthieu, Kilkenny Jessica

机构信息

Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California.

出版信息

Vet Surg. 2016 Nov;45(S1):O49-O59. doi: 10.1111/vsu.12534. Epub 2016 Aug 9.

Abstract

OBJECTIVE

To report the complications and outcome of dogs undergoing laparoscopic cholecystectomy for uncomplicated gall bladder disease.

STUDY DESIGN

Multi-institutional case series.

ANIMALS

Client-owned dogs (n=20).

METHODS

Medical records of dogs that underwent laparoscopic cholecystectomy were reviewed and signalment, history, clinical and ultrasound examination findings, surgical variables, and complications were collated. Laparoscopic cholecystectomy was performed using a multiport approach. Data were compared between dogs with successful laparoscopic cholecystectomy and dogs requiring conversion to open cholecystectomy.

RESULTS

Six dogs (30%) required conversion from laparoscopic to open cholecystectomy due to inability to ligate the cystic duct (3), evidence of gall bladder rupture (1), leakage from the cystic duct during dissection (1), and cardiac arrest (1). Cystic duct dissection was performed in 19 dogs using an articulating dissector (10), right angle forceps (7), and unrecorded (2). The cystic duct was ligated in 15 dogs using surgical clips (5), suture (6), or a combination (4). All dogs were discharged from the hospital and had resolution of clinical signs, although 1 dog developed pancreatitis and 1 dog required revision surgery for bile peritonitis. There was no significant difference in preoperative blood analysis results, surgical technique, or duration of hospitalization between dogs undergoing laparoscopic cholecystectomy and cases converted to open cholecystectomy.

CONCLUSION

Laparoscopic cholecystectomy can be performed successfully for uncomplicated gall bladder disease in dogs after careful case selection. The surgeon considering laparoscopic cholecystectomy should be familiar with a variety of methods for cystic duct dissection and ligation to avoid difficulties during the procedure.

摘要

目的

报告因单纯胆囊疾病接受腹腔镜胆囊切除术的犬只的并发症及结局。

研究设计

多机构病例系列。

动物

客户拥有的犬只(n = 20)。

方法

回顾接受腹腔镜胆囊切除术的犬只的病历,整理其特征、病史、临床及超声检查结果、手术变量和并发症。采用多端口方法进行腹腔镜胆囊切除术。比较成功进行腹腔镜胆囊切除术的犬只与需要转为开腹胆囊切除术的犬只的数据。

结果

6只犬(30%)因无法结扎胆囊管(3只)、胆囊破裂迹象(1只)、解剖过程中胆囊管渗漏(1只)和心脏骤停(1只)而需要从腹腔镜转为开腹胆囊切除术。19只犬使用关节式解剖器(10只)、直角钳(7只)和未记录的方法(2只)进行胆囊管解剖。15只犬使用手术夹(5只)、缝线(6只)或联合使用(4只)结扎胆囊管。所有犬只均出院,临床症状消失,尽管1只犬发生胰腺炎,1只犬因胆汁性腹膜炎需要再次手术。接受腹腔镜胆囊切除术的犬只与转为开腹胆囊切除术的病例在术前血液分析结果、手术技术或住院时间方面无显著差异。

结论

经过仔细的病例选择,腹腔镜胆囊切除术可成功用于犬只的单纯胆囊疾病。考虑进行腹腔镜胆囊切除术的外科医生应熟悉多种胆囊管解剖和结扎方法,以避免手术过程中出现困难。

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