中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 3
Mar.  2018
Turn off MathJax
Article Contents

A clinical study of endoscopic naso-gallbladder drainage-assisted laparoscopic subtotal cholecystectomy

DOI: 10.3969/j.issn.1001-5256.2018.03.014
  • Published Date: 2018-03-20
  • Objective To summarize our experience in endoscopic naso-gallbladder drainage ( ENGBD) -assisted laparoscopic subtotal cholecystectomy ( LSC) in patients with chronic atrophic cholecystitis. Methods A retrospective analysis was performed for the clinical data of 124 patients with chronic atrophic cholecystitis complicated by secondary common bile duct stones who were admitted to Department of Hepatobiliary Surgery in Chongqing Hospital of Armed Police Force, Department of General Surgery in The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, and Department of General Surgery in Chongqing Traditional Chinese Medicine Hospital from January 2007 to December 2016. All patients underwent endoscopic retrograde cholangiopancreatography ( ERCP) , sphincterotomy, and lithotomy. The patients undergoing ENGBD were enrolled as experimental group ( group A with 47 patients) , and those undergoing endoscopic nasobiliary drainage ( ENBD) were enrolled as control group ( group B with 77 patients) . All patients were treated with laparoscopic cholecystectomy ( LC) or LSC after ERCP, and the patients in difficult conditions were converted to open cholecystectomy ( OC) . The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Compared with group B, group A had a significantly higher success rate of LSC ( 53. 2% vs 20. 8%) and a significantly lower proportion of patients undergoing OC ( 4. 3% vs 35. 1%) . Due to the complicated conditions such as internal fistula between the gallbladder and adjacent organs ( including Mirizzi syndrome) , unsuspected gallbladder carcinoma, and cystic duct abnormalities, group B had a great difficulty in the placement of ENGBD, which led to injuries in the hepatic artery/vein, and some patients were converted to open surgery due to concerns of bile duct injury. Conclusion In patients with chronic atrophic cholecystitis with secondary choledocholithiasis, ENGBD after ERCP helps with the successful performance of LSC and can effectively reduce the proportion of conversion to laparotomy.

     

  • loading
  • [1]KUWABARA J, WATANABE Y, KAMEOKA K, et al.Usefulness of laparoscopic subtotal cholecystectomy with operative cholangiography for severe cholecystitis[J].Surg Today, 2014, 44 (3) :462-465.
    [2]SHIN M, CHOI N, YOO Y, et al.Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy[J].Ann Surg Treat Res, 2016, 91 (5) :226-232.
    [3]LI GK, LI X, FENG L, et al.Application of laparoscopic and endoscopic procedures in patients with Csendes I Mirizzi Syndrome:report of 11 cases[J/CD].Chin J Laparoscopic Surgery:Electronic Edition, 2016, 9 (2) :100-105. (in Chinese) 李广阔, 李鑫, 冯犁, 等.腹腔镜、内镜在Mirizzi综合征I型患者中的应用 (附11例报告) [J/CD].中华腔镜外科杂志:电子版, 2016, 9 (2) :100-105.
    [4]ZHONG H, GONG JP.Mirizzi syndrome:experience in diagnosis and treatment of 25 cases[J].Am Surg, 2012, 78 (1) :61-65.
    [5]KAPLAN D, INABA K, CHOULIARAS K, et al.Subtotal cholecystectomy and open total cholecystectomy:alternatives in complicated cholecystitis[J].Am Surg, 2014, 80 (10) :953-955.
    [6]STRASBERG SM, PUCCI MJ, BRUNT LM, et al.Subtotal cholecystectomy-"fenestrating"vs"reconstituting"subtypes and the prevention of bile duct injury:definition of the optimal procedure in difficult operative conditions[J].J Am Coll Surg, 2016, 222 (1) :89-96.
    [7]ELSHAER M, GRAVANTE G, THOMAS K, et al.Subtotal cholecystectomy for“difficult gallbladders”:systematic review and Meta-analysis[J].JAMA Surg, 2015, 150 (2) :159-168.
    [8]SINHA I, SMITH ML, SAFRANEK P, et al.Laparoscopic subtotal cholecystectomy without cystic duct ligation[J].Br J Surg, 2007, 94 (12) :1527-1529.
    [9]JAIN N, NEOGI S, BALI RS, et al.Relationship of gallbladder perforation and bacteriobilia with occurrence of surgical site infections following laparoscopic cholecystectomy[J].Minim Invasive Surg, 2015, 2015:204508.
    [10]PARK SJ, LEE KY, PARK JW, et al.A preliminary study for the development of indices and the current state of surgical site infection (SSIs) in Korea:the Korean Surgical Site Infection Surveillance (KOSSIs) program[J].Ann Surg Treat Res, 2015, 88 (3) :119-125.
    [11]TANG SL, LI JJ, ZHANG XB, et al.Experience in perioperative management in difficult laparoscopic cholecystectomy[J].J Clin Hepatol, 2014, 30 (9) :910-912. (in Chinese) 唐世龙, 李君久, 张小兵, 等.困难性腹腔镜胆囊切除术围手术期处理体会[J].临床肝胆病杂志, 2014, 30 (9) :910-912.
    [12]ZHENG QZ, ZHANG JF, XIE ZR, et al.Analysis of influencing factors for conversion of laparoscopic cholecystectomy to open surgery[J].J Clin Hepatol, 2015, 31 (10) :1671-1674. (in Chinese) 郑奇志, 张剑锋, 谢湛荣, 等.腹腔镜胆囊切除术中转开腹的影响因素分析[J].临床肝胆病杂志, 2015, 31 (10) :1671-1674.
    [13]LIU H, FAN MM, CHANG YX, et al.Clincal analysis of cases converted to open surgery during laparoscopic cholecystectomy[J].Chin J Med Offic, 2016, 44 (8) :809-811. (in Chinese) 刘虎, 范明明, 常颜信, 等.腹腔镜胆囊切除术中转开腹临床分析[J].临床军医杂志, 2016, 44 (8) :809-811.
    [14]JEONG IO, KIM JY, CHOE YM, et al.Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis[J].Korean J Hepatobiliary Pancreat Surg, 2011, 15 (4) :225-230.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2420) PDF downloads(412) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return