Shwaartz Chaya, Pery Ron, Cordoba Mordechay, Gutman Mordechai, Rosin Danny
Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2020 Sep;22(9):538-541.
The safe completion of cholecystectomy is dependent on proper identification and secure closure of the cystic duct. Effecting this closure poses a great challenge when inflammatory changes obscure the anatomy. Subtotal cholecystectomy allows for near complete removal of the gallbladder and complete evacuation of the stones while avoiding dissection in the hazardous area.
To describe experience with laparoscopic subtotal cholecystectomy.
Subtotal cholecystectomy was performed when the critical view of safety could not be achieved. Surgical technique was similar in all cases and included opening the Hartmann's pouch, removing stones obstructing the gallbladder outlet, and identifying the opening of the cystic duct, as well as circumferential transection of the gallbladder neck, closure of the gallbladder stump, and excision of the gallbladder fundus. Data retrieved from patient charts included demographics, pre-operative history, operative and postoperative course, and late complications. No bile duct injuries were observed in this series.
A total of 53 patients underwent laparoscopic subtotal cholecystectomy (2010-2018). Ten patients were operated during the acute course of the disease and 43 electively. Acute cholecystitis was the leading cause for gallbladder removal. Cholecystostomy tube was placed in 18 patients during acute hospitalization. The gallbladder remnant was closed and a drain was placed in most patients. Of the 53 patients, 42 had an uneventful postoperative course.
Laparoscopic subtotal cholecystectomy is an effective surgical technique to avoid bile duct injury when the cystic duct cannot safely be identified. Subtotal cholecystectomy has acceptable morbidity and obviates the need for conversion in these difficult cases.
胆囊切除术的安全完成取决于胆囊管的正确识别和可靠闭合。当炎症改变使解剖结构模糊不清时，实现这种闭合面临巨大挑战。次全胆囊切除术可近乎完全切除胆囊并彻底清除结石，同时避免在危险区域进行解剖。
描述腹腔镜次全胆囊切除术的经验。
当无法获得安全的关键视野时，进行次全胆囊切除术。所有病例的手术技术相似，包括打开哈特曼袋、取出阻塞胆囊出口的结石、识别胆囊管开口、环形横断胆囊颈部、闭合胆囊残端以及切除胆囊底部。从患者病历中获取的数据包括人口统计学资料、术前病史、手术及术后过程以及远期并发症。本系列未观察到胆管损伤。
共有53例患者接受了腹腔镜次全胆囊切除术（2010 - 2018年）。10例患者在疾病急性期接受手术，43例为择期手术。急性胆囊炎是胆囊切除的主要原因。18例患者在急性住院期间放置了胆囊造瘘管。大多数患者的胆囊残端被闭合并放置了引流管。53例患者中，42例术后恢复顺利。
当无法安全识别胆囊管时，腹腔镜次全胆囊切除术是一种避免胆管损伤的有效手术技术。次全胆囊切除术具有可接受的发病率，并且在这些困难病例中无需中转手术。
