Takamatsu Yuichi, Yasukawa Daiki, Aisu Yuki, Hori Tomohide
Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan.
Am J Case Rep. 2018 Aug 16;19:962-968. doi: 10.12659/AJCR.909586.
BACKGROUND Experience alone is insufficient to ensure successful laparoscopic cholecystectomy (LC), although LC has become widespread worldwide. Iatrogenic biliary injuries occur beyond the learning curve. CASE REPORT Biliary injury during laparoscopic cholecystectomy results from anatomical misidentification. The use of a critical view of safety has been established, to identify the cystic artery and the cystic duct, as the cystic duct can be hidden by inflammation (infundibular cystic duct). Seven patients who underwent emergency laparoscopic cholecystectomy due to acute cholecystitis are presented who underwent a critical view of safety protocol during surgery. Five men and two women (mean age, 63.0±13.0 years) included five cases of acute severe cholecystitis and two cases of acute moderate cholecystitis. The mean operative time to complete the critical view of safety exposure was 54.0±17.4 minutes. No cases underwent conversion to open surgery. The mean postoperative duration to ambulation and normal diet was 0.7±0.5 days and 1.0±0.6 days, respectively. The mean time to postoperative patient discharge was 3.9±0.9 days. In all seven cases, the postoperative course was uneventful. The protocol for this surgical procedure is presented, with schematic figures and videos. CONCLUSIONS A case series of seven patients who presented with moderate-to-severe acute cholecystitis and who underwent laparoscopic cholecystectomy, showed good postoperative outcome without surgical complications, using a using a critical view of safety protocol.
背景 尽管腹腔镜胆囊切除术（LC）已在全球广泛开展，但仅靠经验不足以确保手术成功。医源性胆管损伤在学习曲线之外仍会发生。病例报告 腹腔镜胆囊切除术中的胆管损伤源于解剖结构误认。已确立采用安全关键视野来识别胆囊动脉和胆囊管，因为胆囊管可能被炎症隐藏（漏斗状胆囊管）。本文介绍了7例因急性胆囊炎接受急诊腹腔镜胆囊切除术的患者，他们在手术过程中采用了安全关键视野方案。其中5名男性和2名女性（平均年龄63.0±13.0岁），包括5例急性重症胆囊炎和2例急性中度胆囊炎。完成安全关键视野暴露的平均手术时间为54.0±17.4分钟。无一例转为开腹手术。术后平均下床活动时间和恢复正常饮食时间分别为0.7±0.5天和1.0±0.6天。患者术后平均出院时间为3.9±0.9天。所有7例患者术后过程均顺利。本文还展示了该手术操作的方案，并配有示意图和视频。结论 一组7例患有中度至重度急性胆囊炎并接受腹腔镜胆囊切除术的患者，采用安全关键视野方案，术后效果良好，无手术并发症。
