Boyd Kirsten, Bradley Nicholas A, Cannings Elizabeth, Shearer Christopher, Wadhawan Himanshu, Wilson Michael S J, Crumley Andrew
Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.
Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.
HPB (Oxford). 2022 May;24(5):759-763. doi: 10.1016/j.hpb.2021.10.003. Epub 2021 Oct 22.
Laparoscopic subtotal cholecystectomy is a recognised safe, alternative strategy when a critical view of safety cannot be obtained. This study audits the change in practice at a District General Hospital following the adoption of subtotal cholecystectomy in 2013.
Retrospective case series included consecutive cholecystectomies over a ten-year period in a single institution. Cases were divided into subgroups based on operation date. Primary outcome was the proportion of patients undergoing laparoscopic total cholecystectomy, laparoscopic subtotal and laparoscopic converted to open cholecystectomy. Secondary outcomes included incidence of bile leak, complication rate, return to theatre, and length of stay.
There were 4217 cases: 1381 in Group A (pre-adoption of subtotal cholecystectomy 2009-2012), and 2836 in Group B (post-adoption of subtotal cholecystectomy 2013-2019). The rate of laparoscopic total cholecystectomy was higher in Group A than Group B (95.4% vs. 92.8%, p < 0.001). In the subtotal group (n = 114, 14 (12.3%) patients had bile leak, 6 (5.3%) underwent re-laparoscopy, and median length of stay was 2 days.
Laparoscopic subtotal cholecystectomy appears to be an acceptable alternative technique at this centre, reducing the rate of open conversion and length of stay, with a low reintervention rate for bile leak.
当无法获得安全的关键视野时，腹腔镜次全胆囊切除术是一种公认的安全替代策略。本研究对一家地区综合医院在2013年采用次全胆囊切除术后的实践变化进行了审核。
回顾性病例系列研究纳入了在单一机构进行的为期十年的连续胆囊切除术病例。根据手术日期将病例分为亚组。主要结局是接受腹腔镜全胆囊切除术、腹腔镜次全胆囊切除术和腹腔镜中转开腹胆囊切除术的患者比例。次要结局包括胆漏发生率、并发症发生率、再次手术率和住院时间。
共有4217例病例：A组1381例（2009 - 2012年次全胆囊切除术采用前），B组2836例（2013 - 2019年次全胆囊切除术采用后）。A组腹腔镜全胆囊切除术的比例高于B组（95.4%对92.8%，p < 0.001）。在次全胆囊切除术组（n = 114）中，14例（12.3%）患者发生胆漏，6例（5.3%）接受了再次腹腔镜检查，中位住院时间为2天。
在该中心，腹腔镜次全胆囊切除术似乎是一种可接受的替代技术，可降低中转开腹率和住院时间，胆漏再次干预率较低。
