Martin I G, Dexter S P, Marton J, Gibson J, Asker J, Firullo A, McMahon M J
Leeds Institute for Minimally Invasive Therapy, Division of Surgery, General Infirmary at Leeds, UK.
Surg Endosc. 1995 Feb;9(2):203-6. doi: 10.1007/BF00191967.
Removal of the gallbladder with commencement of dissection at the fundus is well recognized as a safe technique during difficult "open" cholecystectomy because it minimizes the risks of damage to the structures in or around Calot's triangle. We report here the routine employment of liver retractors and fundus-first dissection during laparoscopic cholecystectomy (LC) as an alternative to techniques previously described. Retraction of the liver and "fundus-first" dissection was used in 53 patients who underwent laparoscopic cholecytectomy. There were 16 male and 37 female patients. Seven were operations performed during an acute admission and 20 had moderate or severe adhesions involving the gallbladder. Thirteen patients had a preexisting abdominal incision. The procedure was successful in 52 patients (98%), but in one patient it was converted to open operation because of dense adhesions. Median duration of operation was 90 min (range 35-240 min). There was no mortality and two complications (persistent right upper quadrant pain for 2 weeks after operation and bile leakage from the gallbladder bed). The facility to retract the liver and carry out a fundus-first dissection extends techniques developed for "open" surgery into the laparoscopic arena. It offers the surgeon the safety and versatility during laparoscopic cholecystectomy that it confers during conventional open surgery.
在困难的“开放”胆囊切除术中，从胆囊底部开始解剖以切除胆囊是一种公认的安全技术，因为它可将损伤胆囊三角内或其周围结构的风险降至最低。我们在此报告在腹腔镜胆囊切除术（LC）中常规使用肝脏牵开器并采用先从底部开始解剖的方法，作为对先前描述技术的一种替代。在53例行腹腔镜胆囊切除术的患者中使用了肝脏牵开和“先从底部开始”解剖的方法。其中男性16例，女性37例。7例手术是在急性入院期间进行的，20例有涉及胆囊的中度或重度粘连。13例患者有既往腹部手术切口。52例患者手术成功（98%），但1例患者因粘连严重而转为开放手术。手术中位持续时间为90分钟（范围35 - 240分钟）。无死亡病例，有2例并发症（术后持续右上腹疼痛2周和胆囊床胆汁漏）。肝脏牵开及先从底部开始解剖的操作将为“开放”手术所开发的技术扩展到了腹腔镜领域。它为外科医生在腹腔镜胆囊切除术中提供了与传统开放手术中相同的安全性和灵活性。
