Retroinfundibular 腹腔镜胆囊切除术与标准腹腔镜胆囊切除术治疗困难病例的比较。

Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases.

机构信息

Department of Surgery, Minia University Hospital, Egypt.

出版信息

Int J Surg. 2017 Jul;43:75-80. doi: 10.1016/j.ijsu.2017.05.044. Epub 2017 May 24.

DOI:10.1016/j.ijsu.2017.05.044

PMID:28552812

Abstract

BACKGROUND

Laparoscopic cholecystectomy becomes the gold standard surgical procedure for treating gallstones. Standard laparoscopic cholecystectomy (SLC) requires proper dissection of Calot's triangle to achieve the critical view of safety. This may be difficult in certain conditions, resulting in higher incidence of bile duct injury and conversion to open. We aimed to compare the outcomes of laparoscopic cholecystectomy by retroinfundibular (RI) approach to that of SLC, in difficult cases.

PATIENTS AND METHODS

This study is prospective cohort study, in which 60 patients were operated by SLC and 65 patients by laparoscopic cholecystectomy by RI approach.

RESULTS

From the total 125 cases, 95 (76%) patients were male and 30 (24%) were female. The mean age was 59.5 ± 5.5 years. The mean operative time in SLC group was 128 ± 17 min VS. 114 ± 10 min in RI group. Conversion to open occurred in 10% in SLC group VS. 1.5% in RI group. Biliary injury occurred in 3.3% in SLC group VS. 0% in RI group. The mean hospital stay in SLC was 3.7 ± 5.3 days VS. 2.1 ± 0.3 days in RI group.

CONCLUSION

In difficult cholecystectomy, RI approach is feasible and safe alternative to SLC.

摘要

背景

腹腔镜胆囊切除术已成为治疗胆囊结石的金标准手术方法。标准腹腔镜胆囊切除术（SLC）需要正确分离胆囊三角，以实现安全的关键视野。但在某些情况下，这可能会很困难，导致胆管损伤和中转开腹的发生率更高。我们旨在比较经后腹膜入路（RI）腹腔镜胆囊切除术与 SLC 在困难情况下的手术结果。

患者和方法

这是一项前瞻性队列研究，其中 60 例患者接受 SLC 治疗，65 例患者接受 RI 腹腔镜胆囊切除术。

结果

在总共 125 例患者中，95 例（76%）为男性，30 例（24%）为女性。平均年龄为 59.5±5.5 岁。SLC 组的平均手术时间为 128±17 分钟，RI 组为 114±10 分钟。SLC 组中转开腹率为 10%，RI 组为 1.5%。SLC 组胆管损伤发生率为 3.3%，RI 组为 0%。SLC 组的平均住院时间为 3.7±5.3 天，RI 组为 2.1±0.3 天。