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Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review
World Journal of Emergency Surgery ( IF 6.0 ) Pub Date : 2021-09-08 , DOI: 10.1186/s13017-021-00392-x
Adriana Toro 1 , Michele Teodoro 2 , Mansoor Khan 3 , Elena Schembari 4 , Salomone Di Saverio 5 , Fausto Catena 6 , Isidoro Di Carlo 7
Affiliation  

Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

中文翻译:

疑难急性胆囊炎次全胆囊切除术:如何通过腹腔镜安全完成手术——系统评价

本研究的目的是阐明用于完成困难胆囊切除术的最佳腹腔镜次全胆囊切除术 (LSTC) 技术。进行了一项审查(1987-2021),搜索“困难胆囊切除术”和/或“次全胆囊切除术”。考虑的 LSTC 技术如下:A 型,后壁附着在肝脏上,胆囊残端的其余部分打开;B 型,与 A 型相似,但树桩关闭;C型,胆囊前后壁均切除,残端闭合;D 型,与 C 型相似,但树桩打开。使用 Dindo-Clavien 分类分析发病率(包括死亡率)。收录了十九篇文章。在筛选的 13,340 名患者中,678 名 (8.2%) 由 LSTC 完成了胆囊切除术:346 名患者 (51.0%) 患有 A 型 LSTC,134 名患者 (19. 8%) 为 B 型 LSTC,198 名患者 (29.2%) 为 C 型 LSTC,198 名患者 (0%) 为 D 型 LSTC。在 83 名患者 (12.2%) 中发现胆漏,并在 58 名患者 (69.9%) 接受 A 型治疗。23 名患者 (3.4%) 出现肝下积液,其中 19 名 (82.6%) 接受 A 型治疗A. 72 名患者 (10.6%) 报告了其他并发症。Dindo–Clavien 分级为 I 级 4、II 级 27、IIIa 级 126、IIIb 级 18、IV 级 0、V 级 3。在 LSTC 的情况下,关闭胆囊残端是最好的避免并发症的方法。必须仔细探查胆囊残端,冲洗腹腔并引流。在 83 名患者 (12.2%) 中发现胆漏,并在 58 名患者 (69.9%) 接受 A 型治疗。23 名患者 (3.4%) 出现肝下积液,其中 19 名 (82.6%) 接受 A 型治疗A. 72 名患者 (10.6%) 报告了其他并发症。Dindo–Clavien 分级为 I 级 4、II 级 27、IIIa 级 126、IIIb 级 18、IV 级 0、V 级 3。在 LSTC 的情况下,关闭胆囊残端是最好的避免并发症的方法。必须仔细探查胆囊残端,冲洗腹腔并引流。在 83 名患者 (12.2%) 中发现胆漏,并在 58 名患者 (69.9%) 接受 A 型治疗。23 名患者 (3.4%) 出现肝下积液,其中 19 名 (82.6%) 接受 A 型治疗A. 72 名患者 (10.6%) 报告了其他并发症。Dindo–Clavien 分级为 I 级 4、II 级 27、IIIa 级 126、IIIb 级 18、IV 级 0、V 级 3。在 LSTC 的情况下,关闭胆囊残端是最好的避免并发症的方法。必须仔细探查胆囊残端,冲洗腹腔并引流。72 名患者(10.6%)报告了其他并发症。Dindo–Clavien 分级为 I 级 4、II 级 27、IIIa 级 126、IIIb 级 18、IV 级 0、V 级 3。在 LSTC 的情况下,关闭胆囊残端是最好的避免并发症的方法。必须仔细探查胆囊残端,冲洗腹腔并引流。72 名患者(10.6%)报告了其他并发症。Dindo–Clavien 分级为 I 级 4、II 级 27、IIIa 级 126、IIIb 级 18、IV 级 0、V 级 3。在 LSTC 的情况下,关闭胆囊残端是最好的避免并发症的方法。必须仔细探查胆囊残端,冲洗腹腔并引流。
更新日期:2021-09-08
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