Talukder M I, Khan M H, Chowdhury F, Ansary A A, Rahman K, Islam N
Dr Md Monoarul Islam Talukdar, Resident Surgeon (Surgery), Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2018 Oct;27(4):757-763.
Laparoscopic cholecystectomy is the gold standard in the treatment of gallstones. This study was carried out to determine the technical difficulties that can be encountered during laparoscopic cholecystectomy and to evaluate the role of ultrasonography in identifying patients at risk of conversion returning to open surgery. The objective of this study was to evaluate the efficacy of preoperative ultrasonography in assessing technical difficulty faced during laparoscopic cholecystectomy in gallstone disease. This was an observational comparative study which was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh from January 2016 to January 2017. A purposive sampling method was applied to select the study sample. A total of 160 patients were included this study. Data processing and analysis were done using SPSS (statistical package for social sciences), version 20. The summarized data were presented in the form of figures and tables with due statistical interpretation. In this study, there was a total of 160 cases, among which 90(56.25%) turned out to have undergone normal laparoscopic cholecystectomies. Seventy (43.75%) were difficult, among which 6(3.75%) were converted to open cholecystectomies. Among 160 patients, 120(75%) were female and 40(25%) were male. There is a total of 136/160 (85%) patients with gallbladder wall thickness <3mm and 24/160 (15%) patients >3mm. Among the 136 patients with gallbladder wall thickness <3mm, there was difficulty in holding the gallbladder in 28(25%) cases, 28(20.6%) had undergone gallbladder perforation, 32(23.5%) had undergone moderate bleeding and only 2(1.5%) had undergone severe bleeding. Among the 24 patients with gallbladder wall thickness >3mm, there was difficulty in holding the gallbladder in 22(91.7%) cases, 18(75%) had undergone gallbladder perforation, 18(75%) had undergone moderate bleeding and only 2(8.33%) had undergone severe bleeding. It shows a total of 124/160 (77.5%) patients with normal gall bladder, 26/160 (16.25%) patients with contracted gallbladder and 10/160 (6.25%) patients with distended gallbladder. Among the 124 patients with normal gallbladder, 16(12.9%) had undergone difficult Calot's dissection, 26(21%) had undergone difficult gallbladder bed dissection, 26(21%) had undergone moderate bleeding and none had undergone severe bleeding. Among 26 patients with contracted gallbladder, 20(76.9%) underwent difficult Calot's dissection, 24(92.3%) had undergone difficult gallbladder bed dissection, 18(69.2%) had undergone moderate bleeding and 4(15.4%) had undergone severe bleeding. Among 10 patients with distended gallbladder, 4(40%) underwent difficult Calot's dissection, 6(60%) underwent difficult gallbladder bed dissection, 6(60%) had undergone moderate bleeding and none had undergone severe bleeding. From this study, we conclude that preoperative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.
腹腔镜胆囊切除术是治疗胆结石的金标准。本研究旨在确定腹腔镜胆囊切除术过程中可能遇到的技术困难，并评估超声检查在识别有转为开腹手术风险患者中的作用。本研究的目的是评估术前超声检查在评估胆结石疾病患者腹腔镜胆囊切除术所面临技术难度方面的有效性。这是一项观察性比较研究，于2016年1月至2017年1月在孟加拉国达卡的谢赫·苏赫拉瓦迪医学院及医院外科进行。采用目的抽样方法选择研究样本。本研究共纳入160例患者。使用社会科学统计软件包（SPSS）20版进行数据处理和分析。汇总数据以图表形式呈现并进行适当的统计解释。本研究共有160例病例，其中90例（56.25%）成功进行了正常的腹腔镜胆囊切除术。70例（43.75%）手术困难，其中6例（3.75%）转为开腹胆囊切除术。160例患者中，120例（75%）为女性，40例（25%）为男性。共有136/160（85%）例患者胆囊壁厚度<3mm，24/160（15%）例患者胆囊壁厚度>3mm。在胆囊壁厚度<3mm的136例患者中，28例（25%）难以夹持胆囊，28例（20.6%）发生胆囊穿孔，32例（23.5%）出现中度出血，仅2例（1.5%）出现严重出血。在胆囊壁厚度>3mm的24例患者中，22例（91.7%）难以夹持胆囊，18例（75%）发生胆囊穿孔，18例（75%）出现中度出血，仅2例（8.33%）出现严重出血。共有124/160（77.5%）例患者胆囊正常，26/160（16.25%）例患者胆囊收缩，10/160（6.25%）例患者胆囊扩张。在124例胆囊正常的患者中，16例（12.9%）进行了困难的胆囊三角解剖，26例（21%）进行了困难的胆囊床解剖，26例（21%）出现中度出血，无严重出血病例。在26例胆囊收缩的患者中，20例（76.9%）进行了困难的胆囊三角解剖，24例（92.3%）进行了困难的胆囊床解剖，18例（69.2%）出现中度出血，4例（15.4%）出现严重出血。在10例胆囊扩张的患者中，4例（40%）进行了困难的胆囊三角解剖，6例（60%）进行了困难的胆囊床解剖，6例（60%）出现中度出血，无严重出血病例。从本研究中，我们得出结论，术前超声检查在大多数情况下是腹腔镜胆囊切除术难度的良好预测指标，应作为一种筛查方法使用。
