Yildirim Ali Cihat, Zeren Sezgin, Ekici Mehmet Fatih, Yaylak Faik, Algin Mustafa Cem, Arik Ozlem
General Surgery, Kutahya Health Sciences University, Kutahya, TUR.
Biostatistics, Kutahya Health Sciences University, Kutahya, TUR.
Cureus. 2022 Feb 21;14(2):e22441. doi: 10.7759/cureus.22441. eCollection 2022 Feb.
Purpose Cholecystectomy is one of the most frequently performed surgeries. Although laparoscopy is considered the gold standard approach, it cannot prevent biliary injuries. Subtotal cholecystectomy has been performed mainly to prevent biliary injuries during difficult cholecystectomies. This study aimed to analyse our subtotal cholecystectomy results for difficult cholecystectomy cases and to evaluate the fenestrating and reconstituting techniques. Methods Retrospective data were collected and analysed statistically for cases that underwent subtotal cholecystectomy in a single referral centre between 2015 and 2020. Comparisons were made of the patients' age, gender, preoperative American Society of Anaesthesiologists (ASA) score, comorbidities, surgical timing, surgical procedure choice, postoperative complications, and mortality. Results The number of patients who underwent subtotal cholecystectomy was 46; 30.4% underwent emergent surgery and 69.6% underwent elective surgery. Twelve patients had subtotal fenestrating cholecystectomy and 34 had subtotal reconstituting cholecystectomy. Wound issues were noted in 17.4% of the patients, while 10.9% had temporary biliary fistulas that resolved spontaneously. Reoperation was performed in one patient due to high-output biliary drainage. Patients with postoperative complications had significantly higher co-morbid conditions (p=0.000), but surgery timing (p=0.192) and type of subtotal cholecystectomy (p=0.409) had no statistically significant effect on complications. Mortality showed a statistically significant correlation with patient comorbidities, surgery timing, and the type of procedure (p<0.05). Postoperative complications showed a statistically significant correlation with mortality (p<0.05). Conclusion Subtotal cholecystectomy prevents major biliary complications after cholecystectomy. Yet, the frequency of postoperative complications after subtotal cholecystectomy is incontrovertible. Intraoperative characteristics and the surgeon's expertise decide the optimal choice of the subtotal cholecystectomy technique.
目的 胆囊切除术是最常施行的手术之一。尽管腹腔镜手术被视为金标准术式，但它无法预防胆管损伤。次全胆囊切除术主要是为了在困难胆囊切除术中预防胆管损伤而施行。本研究旨在分析我们针对困难胆囊切除术病例的次全胆囊切除术结果，并评估开窗和重建技术。方法 收集了2015年至2020年在单一转诊中心接受次全胆囊切除术病例的回顾性数据，并进行统计学分析。比较了患者的年龄、性别、术前美国麻醉医师协会（ASA）评分、合并症、手术时机、手术方式选择、术后并发症及死亡率。结果 接受次全胆囊切除术的患者有46例；30.4%接受了急诊手术，69.6%接受了择期手术。12例患者接受了次全开窗胆囊切除术，34例接受了次全重建胆囊切除术。17.4%的患者出现伤口问题，10.9%有暂时性胆瘘且自行愈合。1例患者因高流量胆瘘引流而再次手术。术后有并发症的患者合并症显著更多（p=0.000），但手术时机（p=0.192）和次全胆囊切除术类型（p=0.409）对并发症无统计学显著影响。死亡率与患者合并症、手术时机及手术方式类型有统计学显著相关性（p<0.05）。术后并发症与死亡率有统计学显著相关性（p<0.05）。结论 次全胆囊切除术可预防胆囊切除术后的主要胆管并发症。然而，次全胆囊切除术后的术后并发症发生率是不容置疑的。术中特征及外科医生的专业技能决定了次全胆囊切除术技术的最佳选择。
