Treatment principles and surgical skills in laparoscopic subtotal cholecystectomy for acute cholecystitis
10.3760/cma.j.issn.1007-8118.2017.09.010
- VernacularTitle:“困难型”腹腔镜胆囊部分切除的手术技巧与处理原则
- Author:
Wei YAN
1
;
Tianxiong LI
;
Zhipeng SUN
;
Guangzhong XU
;
Peirong TIAN
;
Dongdong ZHANG
;
Gang YIN
;
Dexiao DU
;
Kai LI
Author Information
1. 100038,首都医科大学附属北京世纪坛医院普外科
- Keywords:
Acute cholecystitis;
Laparoscopic subtotal cholecystectomy;
Surgical complication;
Surgical skills
- From:
Chinese Journal of Hepatobiliary Surgery
2017;23(9):615-618
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the treatment principles and surgical skills in laparoscopic subtotal cholecystectomy (LSC) for acute cholecystitis.Methods We retrospectively analyzed the clinical data of patients who underwent LSC for acute cholecystitis from Jan.2006 to Dec.2015 at the Beijing Shijitan Hospital,Capital Medical University.We dissected any serious pericholecystic adhesions according to the principle that "It is better that the gallbladder rather than other tissue is injured",and the technique that "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the cholecystic duct,then the opened cholecystic duct is sutured inside the gallbladder".Results LSC was completed successfully in 96 patients.There were no conversion to open surgery,and no bile duct injury.The mean surgery time was (108.0 ± 37.0) min,the mean blood loss was (121.0 ± 62.0) ml,the mean peritoneal drainage was (105.0 ± 32.0) ml.The drainage tube was removed at a mean of (3.4 ±1.2) d after surgery.The mean hospitalization time after surgery was (6.1 ± 2.2) d.Surgical complications occurred in 2 patients with bleeding after surgery.One patient underwent laparoscopic exploration to stop bleeding.Another patient underwent conservative treatment and the bleeding stopped spontaneously.There were 3 patients who had mild bile leakage.All these patients recovered well after drainage.No patient developed bile duct stenosis or obstructive jaundice on follow-up.Conclusions LSC for acute cholecystitis was safe.Bile duct injuries could be avoided if we follow the principle of "It is better that the gallbladder rather than other tissue is injured" and the technique of "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the gallbladder,then the opened cholecystic duct is sutured inside the gallbladder".
