General Surgery, Augusta Hospital, Siracusa, Italy.
Department of Emergency, S. Marco Hospital, Catania, Italy.
World J Emerg Surg. 2021 Sep 8;16(1):45. doi: 10.1186/s13017-021-00392-x.
Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy.
A review was performed (1987-2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo-Clavien classification.
Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo-Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V.
In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.
本研究旨在明确最终完成困难性胆囊切除术的最佳腹腔镜胆囊次全切除术（LSTC）技术。
对 1987 年至 2021 年期间的“困难性胆囊切除术”和/或“胆囊次全切除术”相关文献进行回顾性分析。所考虑的 LSTC 技术如下：A 型，保留胆囊后壁与肝脏相连，胆囊残端开放；B 型，与 A 型相似，但残端关闭；C 型，切除前壁和后壁，残端关闭；D 型，与 C 型相似，但残端开放。采用 Dindo-Clavien 分类法分析并发症（包括死亡率）。
共纳入 19 篇文章。在筛选的 13340 例患者中，678 例（8.2%）通过 LSTC 最终完成胆囊切除术：346 例（51.0%）采用 A 型 LSTC，134 例（19.8%）采用 B 型 LSTC，198 例（29.2%）采用 C 型 LSTC，198 例（0%）采用 D 型 LSTC。83 例（12.2%）发生胆漏，其中 58 例（69.9%）采用 A 型治疗。23 例（3.4%）发生肝下积液，其中 19 例（82.6%）采用 A 型治疗。72 例（10.6%）发生其他并发症。Dindo-Clavien 分级为 I 级 4 例，II 级 27 例，IIIa 级 126 例，IIIb 级 18 例，IV 级 0 例，V 级 3 例。
在 LSTC 的情况下，闭合胆囊残端是避免并发症的最佳方法。必须仔细探查胆囊残端，彻底冲洗腹腔并留置引流。
