Zhang Rui-Hui, Wang Xiang-Nan, Ma Yue-Feng, Tang Xue-Qian, Lin Mei-Ju, Shi Li-Jun, Li Jing-Yi, Zhang Hong-Wei
Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Ann Hepatobiliary Pancreat Surg. 2025 May 31;29(2):192-198. doi: 10.14701/ahbps.25-010. Epub 2025 Apr 16.
Laparoscopic subtotal cholecystectomy (LSC) has been a safe and viable alternative to conversion to laparotomy in cases of severe cholecystitis. The objective of this study is to determine the utility of intraoperative choledochoscopy in LSC for the exploration of the gallbladder, cyst duct, and subsequent stone clearance of the cystic duct in cases of severe cholecystitis. A total of 72 patients diagnosed with severe cholecystitis received choledochoscopy-assisted laparoscopic subtotal cholecystectomy (CALSC). A choledochoscopy was performed to explore the gallbladder cavity and/or cystic duct, and to extract stones using a range of techniques. The clinical records, including the operative records and outcomes, were subjected to analysis. No LSC was converted to open surgery, and no bile duct or vascular injuries were sustained. All stones within the cystic duct were removed by a combination of techniques, including high-frequency needle knife electrotomy, basket, and electrohydraulic lithotripsy. A follow-up examination revealed the absence of residual bile duct stones, with the exception of one common bile duct stone, which was extracted via endoscopic retrograde cholangiopancreatography. In certain special cases, CALSC may prove to be an efficacious treatment for the management of severe cholecystitis. This technique allows for optimal comprehension of the situation within the gallbladder cavity and cystic duct, facilitating the removal of stones from the cystic duct and reducing the residue of the non-functional gallbladder remnant.
腹腔镜次全胆囊切除术（LSC）已成为重症胆囊炎病例中转开腹手术的一种安全可行的替代方法。本研究的目的是确定术中胆道镜检查在LSC中用于探查胆囊、胆囊管以及在重症胆囊炎病例中随后清除胆囊管结石的效用。共有72例诊断为重症胆囊炎的患者接受了胆道镜辅助腹腔镜次全胆囊切除术（CALSC）。进行胆道镜检查以探查胆囊腔和/或胆囊管，并使用一系列技术取出结石。对包括手术记录和结果在内的临床记录进行分析。没有LSC转为开放手术，也没有发生胆管或血管损伤。通过高频针刀电切术、网篮和液电碎石术等多种技术联合，清除了胆囊管内的所有结石。随访检查发现除1例经内镜逆行胰胆管造影术取出的胆总管结石外，无残余胆管结石。在某些特殊情况下，CALSC可能被证明是治疗重症胆囊炎的有效方法。该技术能够最佳地了解胆囊腔和胆囊管内的情况，便于从胆囊管中取出结石，并减少无功能胆囊残余物的残留。
