Segal Michael S, Huynh Richard H, Wright George O
Department of Surgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
Am J Case Rep. 2017 Feb 21;18:186-189. doi: 10.12659/ajcr.900646.
BACKGROUND Laparoscopic cholecystectomy is a commonly performed surgical procedure. In certain situations visualization of the Callot triangle can become difficult due to inflammation, adhesions, and sclerosing of the anatomy. Without being able to obtain the "critical view of safety" (CVS), there is increased risk of damage to vital structures. An alternative approach to the conventional conversion to an open cholecystectomy (OC) would be a laparoscopic subtotal cholecystectomy (LSC). CASE REPORT We present a case of a 56-year-old male patient with acute cholecystitis with a "difficult gallbladder" managed with LSC. Due to poor visualization of the Callot triangle due to adhesions, safe dissection was not feasible. In an effort to avoid injury to the common bile duct (CBD), dissection began at the dome of the gallbladder allowing an alternative view while ensuring safety of critical structures. CONCLUSIONS We discuss the potential benefits and risks of LSC versus conversion to OC. Our discussion incorporates the pathophysiology that allows LSC in this particular circumstance to be successful, and the considerations a surgeon faces in making a decision in management.
腹腔镜胆囊切除术是一种常见的外科手术。在某些情况下，由于炎症、粘连和解剖结构硬化，胆囊三角的可视化可能会变得困难。如果无法获得“安全关键视野”（CVS），损伤重要结构的风险就会增加。与传统的转为开腹胆囊切除术（OC）不同的另一种方法是腹腔镜次全胆囊切除术（LSC）。病例报告：我们报告一例56岁男性急性胆囊炎患者，其胆囊“情况复杂”，采用LSC治疗。由于粘连导致胆囊三角可视化不佳，无法进行安全的解剖。为避免损伤胆总管（CBD），解剖从胆囊顶部开始，从而获得了另一种视野，同时确保了关键结构的安全。结论：我们讨论了LSC与转为OC的潜在益处和风险。我们的讨论纳入了使LSC在这种特殊情况下取得成功的病理生理学，以及外科医生在做出管理决策时面临的考虑因素。
