The Clinical Analysis on Three-port Laparoscopic Cholecystectomy for Cholecystitis with Gallbladder Calculi Incarceration_West China Medical Journal

Authors：

 ChenSirui , PengYonghai , HuChaohui , LuoHua

Department of Hepatobiliary Surgery, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

Keywords：

Laparoscopic cholecystectomy; Gallbladder calculi incarceration; Clinical analysis

DOI：

10.7507/1002-0179.201600462

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Objective To explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration. Methods The clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation. Results Three-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography. Conclusion s Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.

Citation： ChenSirui, PengYonghai, HuChaohui, LuoHua. The Clinical Analysis on Three-port Laparoscopic Cholecystectomy for Cholecystitis with Gallbladder Calculi Incarceration. West China Medical Journal, 2016, 31(10): 1678-1681. doi: 10.7507/1002-0179.201600462 Copy

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12.	焦大海, 張培新, 王學究, 等.吸引器在困難腹腔鏡膽囊切除術中的應用體會[J].腹腔鏡外科雜志, 2013(7): 533-535.
13.	倪春華, 熊詠, 李壽柏, 等.刮吸解剖法在急性膽囊炎腹腔鏡膽囊切除術中的應用[J].中國微創外科雜志, 2009, 9(5): 450-452.
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15.	倪斌, 魏源水, 朱宏輝.復雜困難腹腔鏡膽囊切除術116例報告[J].中國微創外科雜志, 2011, 11(8): 697-699.
16.	吳昌平, 陳思瑞, 蔡云強.腹腔鏡在治療急性結石嵌頓性膽囊炎中的應用[J].華西醫學, 2010, 25(1): 84-85.

1. Ahmad A, Michel G, Moshe S. Controversies in laparoscopic surgury[M]. Heidelberg: Springer-Verlag, 2006: 215-226.
2. 黃志強.當今膽道外科的發展方向[J].中國外科雜志, 2006, 44(12): 1585-1586.
3. 宋建寧, 羅玉政, 洪明, 等.腹腔鏡膽囊切除治療亞急性膽囊炎的體會[J].中華肝膽外科雜志, 2009, 15(12): 942-943.
4. 陳軍, 楊書斌, 黃德榕.困難腹腔鏡膽囊切除術的應用體會[J].腹腔鏡外科雜志, 2011, 16(5): 382-384.
5. 羅華, 黎前德, 胡朝輝, 等.三孔法腹腔鏡膽囊切除術的體會及應用價值[J].腹腔鏡外科雜志, 2001, 6(2): 85-86.
6. 周景慧.急性結石性膽囊炎行腹腔鏡手術時機的探討[J].肝膽胰外科雜志, 2009, 21(3): 239-240.
7. 朱斌, 張展志, 張能維, 等.急性膽囊炎"延期"腹腔鏡膽囊切除的手術技巧及并發癥預防[J].中華肝膽外科雜志, 2011, 17(10): 820-822.
8. 李堅, 辜天慧, 袁偉, 等.上腹部手術史患者行三孔法腹腔鏡膽囊切除術的臨床分析[J].重慶醫學, 2011, 40(35): 3592-3593.
9. 尹新民, 周海蘭, 吳金術.三孔法腹腔鏡膽囊切除術手術技巧(附1280例報告)[J].中國醫師雜志, 2005, 7(11): 1514-1515.
10. 商永生, 王江, 譚玉成, 等.三孔法腹腔鏡膽囊切除術治療急性膽囊炎236例臨床體會[J].中國醫學工程, 2014, 22(5): 152-153.
11. 陳欽壽, 何龍光, 黎福良, 等.膽囊后三角入路三孔法腹腔鏡膽囊切除術[J].臨床肝膽病雜志, 2012, 28(7): 516-518.
12. 焦大海, 張培新, 王學究, 等.吸引器在困難腹腔鏡膽囊切除術中的應用體會[J].腹腔鏡外科雜志, 2013(7): 533-535.
13. 倪春華, 熊詠, 李壽柏, 等.刮吸解剖法在急性膽囊炎腹腔鏡膽囊切除術中的應用[J].中國微創外科雜志, 2009, 9(5): 450-452.
14. 劉玉林, 吳文慶, 葛建明.腹腔鏡膽囊切除術中出血的臨床處理[J].肝膽胰外科雜志, 2010, 22(6): 514-515.
15. 倪斌, 魏源水, 朱宏輝.復雜困難腹腔鏡膽囊切除術116例報告[J].中國微創外科雜志, 2011, 11(8): 697-699.
16. 吳昌平, 陳思瑞, 蔡云強.腹腔鏡在治療急性結石嵌頓性膽囊炎中的應用[J].華西醫學, 2010, 25(1): 84-85.

West China Medical Journal

The Clinical Analysis on Three-port Laparoscopic Cholecystectomy for Cholecystitis with Gallbladder Calculi Incarceration

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