Al Zoubi Mohammad, El Ansari Walid, Al Moudaris Ahmed A, Abdelaal Abdelrahman
Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skövde, Skövde, Sweden.
Int J Surg Case Rep. 2020;72:454-459. doi: 10.1016/j.ijscr.2020.06.001. Epub 2020 Jun 11.
Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported.
Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone.
Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties.
巨大/大型胆结石具有较高的并发症风险以及手术中的技术难题。本病例系列是有史以来报告的最大规模的。
病例1：女性（44岁），有一年间歇性右上腹绞痛病史。超声检查：大型胆结石（胆囊正常）。择期腹腔镜胆囊切除术（LC）：6×4×3.3厘米胆结石。病例2：女性（41岁），因右上腹疼痛/压痛3天、呕吐且墨菲氏征阳性就诊于急诊室。超声检查：大型胆结石，结石性胆囊炎。急诊LC：4.5×3.1×3.5厘米胆结石。病例3：男性（38岁），有胆结石和急性胆囊炎病史，出现间歇性右上腹疼痛（2个月）及呕吐。腹部检查正常。超声检查：大型胆结石。择期LC：4.1×4×3.6厘米胆结石。
直径>5厘米的胆结石非常罕见，并发症风险更高。即使无症状也应切除胆囊。直径>3厘米的胆结石会增加患胆囊癌、胆肠瘘和肠梗阻的风险。LC存在一些挑战，包括抓住胆囊壁、暴露胆囊三角以及将胆囊从腹腔取出。考虑到在无法暴露解剖结构或术中遇到困难时可能需要转为开腹胆囊切除术，LC似乎是首选手术方式，应由经验丰富的外科医生进行操作。
