Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Am Surg. 2023 Dec;89(12):5372-5378. doi: 10.1177/00031348221148345. Epub 2022 Dec 27.
Although laparoscopic cholecystectomy is one of the most common operations performed, there is no consensus on the best surgical approach when inflammation obscures hepatocystic anatomy in severe cholecystitis. Traditionally, this situation triggered conversion to open cholecystectomy (COC); however, in recent decades, alternative approaches have been described. We compared outcomes of bailout procedures for severe cholecystitis, primarily focusing on COC versus laparoscopic subtotal cholecystectomy (LSTC).
Retrospective review comparing outcomes of intended laparoscopic cholecystectomy cases that were converted to bailout procedures between 2015-2020 at a single institution. Bailout procedures were categorized into LSTC and COC groups. Demographics, clinical presentation, time to surgery, operative indications, operative duration, and post-operative outcomes were compared using independent sample t-tests with Welch-Satterthwaite correction or Wilcoxon rank-sum tests (continuous variables) or Fisher's exact/χ2 tests. A -value of less than .05 was considered significant.
Final analysis included 158 subjects: 55 LSTC and 99 COC. Patient demographics and clinical presentations were similar between groups. LSTC had shorter operative time, fewer ICU admissions, and shorter length of stay than COC ( < .05). There were 9 (9.2%) cases of ileus, 4 (4.0%) cases of post-operative bleeding, and 2 (2.0%) cases of bile duct injury in COC. There was 1 (1.8%) case of ileus, 1 (1.8%) case of post-operative bleeding, and no bile duct injury in LSTC.
LSTC was associated with fewer complications than COC, which had higher rates of biliary injury, bleeding, ileus, ICU admission, and longer hospital stay.
尽管腹腔镜胆囊切除术是最常见的手术之一，但在严重胆囊炎中炎症掩盖了肝胆解剖结构时，对于最佳手术方法仍未达成共识。传统上，这种情况会引发转为开腹胆囊切除术（COC）；然而，近几十年来，已经描述了替代方法。我们比较了严重胆囊炎的抢救手术的结果，主要关注 COC 与腹腔镜胆囊次全切除术（LSTC）。
回顾性比较了 2015 年至 2020 年在一家机构接受腹腔镜胆囊切除术的患者，这些患者在手术中转为抢救性手术。抢救性手术分为 LSTC 和 COC 两组。使用独立样本 t 检验（带 Welch-Satterthwaite 校正或 Wilcoxon 秩和检验）比较两组的一般资料、临床表现、手术时间、手术指征、手术时间和术后结果（连续变量），或 Fisher's exact/χ2 检验。小于.05 的值被认为具有统计学意义。
最终分析包括 158 例患者：55 例 LSTC 和 99 例 COC。两组患者的一般资料和临床表现相似。LSTC 的手术时间更短，ICU 入院率和住院时间更短，而 COC 的 ICU 入院率和住院时间更长（<.05）。COC 中有 9 例（9.2%）发生肠梗阻，4 例（4.0%）发生术后出血，2 例（2.0%）发生胆管损伤。LSTC 中有 1 例（1.8%）发生肠梗阻，1 例（1.8%）发生术后出血，无胆管损伤。
与 COC 相比，LSTC 并发症更少，COC 的胆管损伤、出血、肠梗阻、ICU 入院率和住院时间更长。
