Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Hepatic, Pancreatic and Biliary (HPB) Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Surg Endosc. 2020 Oct;34(10):4536-4542. doi: 10.1007/s00464-019-07242-7. Epub 2019 Nov 7.
In difficult gallbladders, partial or subtotal cholecystectomy (SC) has been described as a reasonable procedure with safe outcomes. Our aim was to look at our data on SC with respect to safety, morbidity and long-term outcome.
A retrospective analysis was performed for 3560 patients undergoing cholecystectomy from January 2010 to June 2016. For patients who underwent SC, demographics, intra-operative and follow-up details were analysed.
A total of 168 SC patients were included. 102 (60.7%) were male while 66 (39.3%) were female. The median age was 63 years (31-87). These patients were on follow-up for a median of 29 months (1.7-80). 153 were attempted laparoscopically and there were 25 (16.3%) patients which had open conversion. The rest of the 15 patients had open SC. Mean operative time 150 min (70-315) and average blood loss was 170 ml (50-1500). Median length of stay for these patients was 4 days (1-68). There were no common bile duct (CBD) injuries. We had 12 (7.1%) post-operative collections, 4 (2.4%) wound infections, 1 (0.6%) bile leak and 7 (4.2%) retained stones. Post-operative endoscopic retrograde cholangiopancreatography (ERCP) was performed on 4 (2.4%) patients with successful retrieval of CBD stones. One patient has spontaneous passage of CBD stone. The rest of the two patients with very small retained stones in remnant gallbladder were successfully managed conservatively. There was no 30-day or operation-related mortality. No patient required a second operation.
SC is safe and feasible when encountering a difficult gallbladder.
在困难的胆囊中，部分或次全胆囊切除术（SC）已被描述为一种安全的手术方法，具有良好的结果。我们的目的是观察我们关于 SC 的数据，以了解安全性、发病率和长期结果。
对 2010 年 1 月至 2016 年 6 月期间行胆囊切除术的 3560 例患者进行回顾性分析。对接受 SC 的患者，分析其人口统计学、术中及随访细节。
共纳入 168 例 SC 患者。男 102 例（60.7%），女 66 例（39.3%）。中位年龄 63 岁（31-87 岁）。这些患者的中位随访时间为 29 个月（1.7-80 个月）。153 例患者行腹腔镜尝试，其中 25 例（16.3%）患者转为开腹。其余 15 例患者行开腹 SC。平均手术时间 150 分钟（70-315 分钟），平均出血量 170ml（50-1500ml）。这些患者的中位住院时间为 4 天（1-68 天）。无胆总管（CBD）损伤。我们有 12 例（7.1%）术后积液，4 例（2.4%）伤口感染，1 例（0.6%）胆漏，7 例（4.2%）残余结石。4 例（2.4%）患者术后行内镜逆行胰胆管造影（ERCP），成功取出 CBD 结石。1 例患者 CBD 结石自行排出。其余两名患者残余胆囊内有非常小的残余结石，经保守治疗成功。无 30 天或手术相关死亡率。无患者需要再次手术。
在遇到困难的胆囊时，SC 是安全可行的。
