Tartaglia Nicola, Cianci Pasquale, Di Lascia Alessandra, Fersini Alberto, Ambrosi Antonio, Neri Vincenzo
Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy.
Open Med (Wars). 2016 Nov 13;11(1):429-432. doi: 10.1515/med-2016-0078. eCollection 2016.
Retrograde approach ("fundus first") is often used in open surgery, while in laparoscopic cholecystectomy (LC) is less frequent. LC, with antegrade access, is done by putting in traction the infundibulum and going up to the fundus before to clip the cystic. Our study analyzes a number of surgical procedures performed by experienced surgeons in laparoscopy. From 2002 to 2015, 1740 laparoscopic cholecystectomies were performed at our Institution. The operative procedure performed since 2002 consists of the incision of the visceral peritoneum from the infundibulum away from Calot's triangle along the gallbladder bed up to the fundus. Then it continues from the fundus up to the infundibulum.
There were no bile duct injuries. Average operative time was 40 min. 22 conversions to an open procedure (1.3%) occurred, in cases of acute cholecystitis and cirrhotic patient. Postoperative stay was mean 2 days with no delayed sequelae on follow up.
gallbladder antegrade dissection for laparoscopic cholecystectomy can reduce the time of surgery and is an easier technique to perform. Therefore, it can be proposed as the standard procedure and not only be used for difficult cholecystectomies.
逆行入路（“先从胆囊底部开始”）常用于开放手术，而在腹腔镜胆囊切除术（LC）中则较少使用。采用顺行入路的LC手术是通过牵拉胆囊漏斗部，向上至胆囊底部，然后再夹闭胆囊管来完成的。我们的研究分析了经验丰富的外科医生在腹腔镜手术中实施的一系列手术操作。2002年至2015年期间，我们机构共进行了1740例腹腔镜胆囊切除术。自2002年以来所采用的手术步骤包括：从胆囊漏斗部远离胆囊三角处切开脏腹膜，沿着胆囊床向上至胆囊底部。然后再从胆囊底部继续操作至胆囊漏斗部。
无胆管损伤发生。平均手术时间为40分钟。在急性胆囊炎和肝硬化患者中，有22例（1.3%）转为开放手术。术后平均住院时间为2天，随访期间无延迟性后遗症。
腹腔镜胆囊切除术采用顺行胆囊剥离术可缩短手术时间，且操作更简便。因此，它可被推荐为标准手术方法，而不仅用于困难的胆囊切除术。
