Preventive strategies of bile duct injury in emergent laparoscopic operations for severe acute cholecystitis
10.3760/cma.j.issn.1007-8118.2016.07.001
- VernacularTitle:重度急性胆囊炎急诊腹腔镜手术时胆管损伤的预防策略
- Author:
Wenbing SUN
- Publication Type:Journal Article
- Keywords:
Severe acute cholecystitis;
Laparoscopic cholecystitis;
Bile duct injury;
Concept;
Strategy
- From:
Chinese Journal of Hepatobiliary Surgery
2016;22(7):433-436
- CountryChina
- Language:Chinese
-
Abstract:
Severe acute cholecytitis (SAC) is the severe type of acute cholecystitis,of which the pathological changes are both severe and complicated,resulting in poor response to conservative treatment.In the recent decade,emergent early laparoscopic cholecystectomy (LC) for SAC is getting more and more attention,but this procedure has both technique difficulties and a relatively high rate of complications including bile duct injury.So specific treatment and technical strategy are needed for LC management of SAC.For SAC,the main objective of emergent LC is to achieve prompt drainage of the gallbladder to alleviate the systemic inflammatory response.Complete removal of stones and gallbladder tissue should depend on the individual condition during LC,and should not be overtreated.The technical strategies for SAC includedome-down dissection technique,subtotal cholecytectomy, inside approach of the gallbladder technique,partial cholecystectomy and crocodile mouth shape incision of gallbladder.Although the names of these technical strategies are different,but the main focus is the same,that is, trying not to touch calot's triangle,not to dissect the cystic duct,with residual gallbladder wall in exchange for clinical safety,the core of which is to bypass the calot's triangle to prevent bile duct injury.In practice,multiple strategies are often applied in a mixed way.
