Greyasov V I, Chuguevsky V M, Sivokon N I, Agapov M A, Abubakarov R S
Department of Surgery and Endosurgery with a course of vascular surgery and angiology, Stavropol State Medical University, Stavropol, Russia; Yessentuki Municipal Hospital, Yessentuki, Russia.
Yessentuki Municipal Hospital, Yessentuki, Russia.
Khirurgiia (Mosk). 2018(2):52-56. doi: 10.17116/hirurgia2018252-56.
To analyze the effect of gallbladder's morpho-functional changes as a risk factor for injury of extrahepatic bile ducts during cholecystectomy.
Laparoscopic cholecystectomy was performed in 20 564 patients. There were 147 64 (71.8%) patients with chronic gallbladder inflammation and 5800 (28.2%) - with acute process. It was performed a retrospective analysis of the incidence and causes of intraoperative trauma of extrahepatic bile ducts and bile outflow. Two groups of comparison were distinguished: acute calculous cholecystitis and chronic inflammation.
There were 93 (0.04%) complications followed by bile outflow (55 (0.94%) in the 1 group and 38 (0.25%) in the 2 group). Marginal injury of the ducts was interoperatively detected in 5 patients of group 1 and 3 patients of 2 groups. In postoperative period it was found in 6 patients of the 1 group due to electric trauma of common bile duct. Complete transection of common bile duct occurred in 10 (8.8%) cases, while chronic calculous cholecystitis was observed in 8 of them. At the same time, in 6 patients these were surgical interventions in scleroatrophic gallbladder. As a results, we determined the forms of non-functioning gallbladder with morphofunctional changes which promote trauma of extrahepatic bile ducts.
Long-term non-functioning gallbladder leads to cicatricial and adhesive processes in its wall and surrounding tissues that significantly complicates cholecystectomy and increases the risk of bile ducts trauma. Scleroatrophic gallbladder is the most dangerous which occurs in 4.1% of patients with chronic calculous cholecystitis. Further trials are advisable to develop optimal therapeutic and diagnostic tactics for various forms of long-term non-functioning gallbladder.
分析胆囊形态功能改变作为胆囊切除术期间肝外胆管损伤危险因素的作用。
对20564例患者实施了腹腔镜胆囊切除术。其中14764例（71.8%）患有慢性胆囊炎，5800例（28.2%）患有急性胆囊炎。对肝外胆管术中创伤及胆汁流出的发生率和原因进行了回顾性分析。区分了两组进行比较：急性结石性胆囊炎组和慢性炎症组。
发生93例（0.04%）胆汁流出并发症（第1组55例（0.94%），第2组38例（0.25%））。第1组5例和第2组3例术中检测到胆管边缘损伤。术后第1组6例因胆总管电灼伤发现胆管损伤。胆总管完全横断发生10例（8.8%），其中8例观察到慢性结石性胆囊炎。同时，6例患者是在硬化萎缩性胆囊进行的手术干预。结果，我们确定了伴有形态功能改变的无功能胆囊的形式，这些改变会促使肝外胆管受到创伤。
长期无功能胆囊会导致其壁及周围组织出现瘢痕形成和粘连过程，这会使胆囊切除术显著复杂化，并增加胆管损伤风险。硬化萎缩性胆囊最为危险，在慢性结石性胆囊炎患者中发生率为4.1%。建议进一步开展试验，以制定针对各种形式长期无功能胆囊的最佳治疗和诊断策略。
