腹腔镜胆囊大部切除术中胆囊管残端的处理

目的:对比分析腹腔镜胆囊大部切除术(laparoscopic subtotal cholecystectomy,LSC)中胆囊管残端关闭处理和开放处理的效果。方法:回顾分析2001年4月至2009年12月为87例患者施行LSC的临床资料,其中胆囊管残端关闭处理(A组)36例,残端开放处理(B组)51例。结果:所有病例均在腹腔镜下完成手术,无胆管损伤等严重并发症发生。A组术后4例发生胆囊管残留综合征(cholecystic duct remnant syndrome,CDRS),均接受再次开腹手术治愈;B组术后8例轻微胆漏,均自行愈合,无CDRS发生。结论:LSC适于困难条件下的胆囊切除;关闭胆囊管残端有可能导致CDRS,适时选择开放残端安全可行,可减少CDRS的发生。

Management of cholecystic duct remnant in laparoscopic subtotal cholecystectomy

Objective:To compare and analyze the outcomes of different managements of cystic duct stump,with or without closure,in laparoscopic subtotal cholecystectomy (LSC).Methods:The clinical data of 87 cases of LSC which were performed during Apr.2001 to Dec.2009 were retrospectively analyzed.36 cases (group A) of them underwent closure of cholecystic duct stump in LSC procedure,while other 51 cases (group B) not.Results:All laparoscopic operations were completed.There was no serious complications such as biliary duct injury in this series.4 cases in group A suffered from cholecystic duct remnant syndrome (CDRS) 11 to 18 months after operation,and all were cured after open surgery.There was no CDRS occurred in group B.However,8 cases presented self-limited biliary leak postoperatively in this group.Conclusions:LSC is a feasible and safe approach.Closure of cystic duct stump during LSC may increase the occurrence of CDRS.LSC without cystic duct stump closure is an alternative solution to reduce occurrence of CDRS.