Belloso R M, Ayala L A, Souchón E A, Henríquez L J, León-Ponte O
Hospital de Clínicas Caracas.
G E N. 1993 Oct-Dec;47(4):226-34.
One-hundred and twenty-seven consecutive patients with acute cholecystitis were operated using laparoscopic technique. Average Surgical operating time was 113 minutes with an average of 127 minutes if operative cholangiogram was performed and 96 minutes when cholangiogram was not done. Technical difficulties related to gallbladder edema and hyperemia was seen in all cases (100%), also poor exposure and difficulty in grasping the gallbladder in 87%. The most common post operative complication was the wound infection of the entry trocar port, mainly at the umbilicus. One patient with gangrenous cholecystitis and multiple organ failure died after endoscopic attempt and converted to open technique. The total number conversions was 3%. In 28% of the patients a ERCP was done with ten positive for common duct stones. Operative cholangiogram was attempted in all cases with 83% success rate and 5% where positive for common duct stones. In cases where ERCP was done postoperatively for suspicious stones, seven cases were positive. Hospital stay averaged 1.6 days. Acute cholecystitis does not contraindicate laparoscopic technique and chances of having concomitant common duct stone is 16%, for that reason radiologic studies are mandatory.
127例连续的急性胆囊炎患者接受了腹腔镜手术。平均手术时间为113分钟,若进行术中胆管造影则平均为127分钟,未进行胆管造影时为96分钟。所有病例(100%)均可见与胆囊水肿和充血相关的技术困难,87%的病例存在暴露不佳和胆囊抓取困难的情况。最常见的术后并发症是穿刺孔伤口感染,主要发生在脐部。1例坏疽性胆囊炎合并多器官功能衰竭的患者在内镜治疗尝试后死亡,随后转为开放手术。总的中转率为3%。28%的患者进行了内镜逆行胰胆管造影(ERCP),其中10例胆总管结石阳性。所有病例均尝试进行术中胆管造影,成功率为83%,5%的病例胆总管结石阳性。术后因怀疑结石而进行ERCP检查的病例中,7例阳性。平均住院时间为1.6天。急性胆囊炎并不禁忌腹腔镜手术,合并胆总管结石的几率为16%,因此影像学检查是必要的。