Braghetto I, Csendes A, Debandi A, Korn O, Bastias J
Department of Surgery, University Hospital, Santiago, Chile.
Surg Laparosc Endosc. 1997 Aug;7(4):310-5.
Laparoscopic cholecystectomy is currently the standard procedure for chronic and acute cholecystitis. The purpose of this prospective study was to evaluate the preoperative ultrasound findings of the gallbladder and correlate those aspects with surgical videoscopic and histopathologic findings and the results concerning intraoperative complications and the conversion index to open surgery. Gallbladder findings were classified into three categories according to the gallbladder wall characteristics and the presence of visible lumen and stones. Simple chronic cholecystitis (type I) and acute cholecystitis, with gallbladder wall thickness <5 mm (type IIa) presented significantly lower intraoperative complications without conversion to open surgery. Scleroatrophic (type III) and acute cholecystitis with gallbladder wall thickness >5 mm (type IIB) presented significantly more surgical difficulties and a higher conversion rate to open surgery (p < 0.01). We postulate that this classification will be useful for surgeons in predicting potential problems in individual patients, at least at the initial laparoscopic cholecystectomy experience, and in advising patients of the potential risks of and conversion to open surgery.
腹腔镜胆囊切除术目前是治疗慢性和急性胆囊炎的标准手术。这项前瞻性研究的目的是评估胆囊的术前超声检查结果，并将这些方面与手术视频镜检查和组织病理学结果以及术中并发症和转为开放手术的转换指数结果相关联。根据胆囊壁特征、可见管腔和结石的存在情况，将胆囊检查结果分为三类。单纯慢性胆囊炎（I型）和胆囊壁厚度<5mm的急性胆囊炎（IIa型）术中并发症明显较少，无需转为开放手术。硬化萎缩型（III型）和胆囊壁厚度>5mm的急性胆囊炎（IIb型）手术难度明显更大，转为开放手术的比率更高（p<0.01）。我们推测，这种分类至少在初次腹腔镜胆囊切除术经验中，对外科医生预测个体患者的潜在问题以及告知患者开放手术的潜在风险和转为开放手术的可能性将是有用的。
