Clipless Laparoscopic Cholecystectomy for Patients with Calculous Cholecystitis in Acute Inflammation Stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUO Guangjun , XU Anan , HU Hai.

Department of Minimally Invasive Surgery, The Affiliated Dongfang Hospital of Tongji University, Shanghai 200120, China;

Corresponding author：

Keywords：

Acute inflammation; Laparoscopic cholecystectomy; Gallstone; Clipless; Electrocautery; Harmonic scalpel

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ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.

Citation： SUO Guangjun,XU Anan,HU Hai.. Clipless Laparoscopic Cholecystectomy for Patients with Calculous Cholecystitis in Acute Inflammation Stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 168-171. doi: Copy

1.	Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines [J]. J Hepatobiliary Pancreat Surg, 2007， 14(1): 9197.
2.	张诗诚, 杜渊, 唐志, 等. 电视腹腔镜胆囊切除术270例报告 [J]. 四川医学, 1993, 14(3): 148150.
3.	王志伟, 罗加兴. 急性结石性胆囊炎的腹腔镜手术治疗（附232例报告） [J]. 中国内镜杂志, 2009, 15(3): 297299.
4.	马良龙, 俞磊, 张书民, 等. 困难性腹腔镜胆囊切除手术方法讨论 [J]. 中华全科医学, 2010, 8(3): 330331.
5.	吴钧, 张平, 王蒙, 等. 肝硬变时腹腔镜胆囊切除术治疗30例胆囊疾病的体会 [J]. 中国普外基础与临床杂志, 2009, 16(12): 10311032.
6.	Hadad SM, Vaidya JS, Baker L, et al. Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis [J]. World J Surg, 2007, 31(6): 12981303.
7.	郭定刚, 陈福春, 邱振明. 腔镜胆囊切除术在坏疽性胆囊炎中的应用 [J]. 肝胆胰外科杂志, 2005, 17(3): 237238.
8.	张展志, 张能维, 朱斌, 等. 急性胆囊炎腹腔镜胆囊切除手术时机的再探讨 [J]. 安徽医药, 2010, 14(1): 5152.
9.	向国安, 陈开运, 肖方联, 等. 胆囊壶腹部结石嵌顿伴胆囊积液的腹腔镜胆囊切除术 [J]. 中国微创外科杂志, 2006, 6(3): 177179.
10.	邵天松, 伍冀湘, 梁杰雄, 等. 急性胆囊炎的腹腔镜手术治疗体会（附212例报告） [J]. 中国微创外科杂志, 2010, 10(9): 821823.
11.	Bessa SS, AlFayoumi TA, Katri KM, et al. Clipless laparoscopic cholecystectomy by ultrasonic dissection [J]. J Laparoendosc Adv Surg Tech A, 2008, 18(4): 593598.
12.	马海, 沈文来, 李杨, 等. “三孔一勾到底法”腹腔镜胆囊切除术1 260例临床总结 [J]. 中国普外基础与临床杂志, 2009, 16(10): 800802.
13.	杨昌平, 郭海鹰, 刘强, 等. 无异物腹腔镜胆囊切除术的研究 [J]. 中华普外科手术学杂志（电子版）, 2010, 4(1): 6972.
14.	Attwell A, Hawes R. Surgical clip migration and choledocholithiasis: a late, abrupt complication of laparoscopic cholecystectomy [J]. Dig Dis Sci, 2007, 52(9): 22542256.
15.	Lee AY, Carter JJ, Hochberg MS, et al. The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital [J]. Am J Surg, 2008, 195(4): 467470.
16.	冯雪峰, 应福明. 腹腔镜治疗急性结石性胆囊炎的手术时机 [J]. 现代实用医学, 2008, 20(5): 352353, 361.
17.	高瑞岗, 李奎, 冯宝华, 等. 腹腔镜胆囊切除术治疗508例急性结石性胆囊炎的临床总结 [J]. 中国内镜杂志, 2008, 14(3): 322324, 329.
18.	刘晓辉, 谢开斌, 李桂良, 等. 胆囊管逆行分离法在急性胆囊炎LC中的应用 [J]. 肝胆外科杂志, 2009, 17(4): 298299.
19.	周骏, 冯来运, 许可, 等. 腹腔镜Hartmann袋切开法在困难胆囊手术中的应用 [J]. 中国普通外科杂志, 2009, 18(3): 306307.
20.	陈彦波, 吴唯. 腹腔镜胆囊大部分切除术临床应用探讨 [J]. 中国普通外科杂志, 2007, 16(2): 195196.
21.	Tian Y, Wu SD, Su Y, et al. Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China [J]. Surg Today, 2009, 39(6): 510513.
22.	Horiuchi A, Watanabe Y, Doi T, et al. Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions [J]. Surg Endosc, 2008, 22(12): 27202723.
23.	倪春华, 熊咏, 李寿柏, 等. 刮吸解剖法在急性胆囊炎腹腔镜胆囊切除术中的应用 [J]. 中国微创外科杂志, 2009, 9(5): 450452.
24.	朱宏毅, 季福, 孔卉玲. 腹腔镜胆囊切除中转开腹手术的危险因素分析 [J]. 中国普通外科杂志, 2009, 18(8): 787789.
25.	詹勇强, 王成友, 张敏杰, 等. 腹腔镜胆囊切除术适应证与并发症的探讨: 附3 002例报告 [J]. 中国普通外科杂志, 2009, 18(8): 797800.
26.	Kanaan SA, Murayama KM, Merriam LT, et al. Risk factors for conversion of laparoscopic to open cholecystectomy [J]. J Surg Res, 2002, 106(1): 2024.
27.	李军, 张辉, 朱雷鸣, 等. 急性结石性胆囊炎行LC术难易程度的相关因素分析 [J]. 中国普通外科杂志, 2009, 18(8): 783785.

1. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines [J]. J Hepatobiliary Pancreat Surg, 2007， 14(1): 9197.
2. 张诗诚, 杜渊, 唐志, 等. 电视腹腔镜胆囊切除术270例报告 [J]. 四川医学, 1993, 14(3): 148150.
3. 王志伟, 罗加兴. 急性结石性胆囊炎的腹腔镜手术治疗（附232例报告） [J]. 中国内镜杂志, 2009, 15(3): 297299.
4. 马良龙, 俞磊, 张书民, 等. 困难性腹腔镜胆囊切除手术方法讨论 [J]. 中华全科医学, 2010, 8(3): 330331.
5. 吴钧, 张平, 王蒙, 等. 肝硬变时腹腔镜胆囊切除术治疗30例胆囊疾病的体会 [J]. 中国普外基础与临床杂志, 2009, 16(12): 10311032.
6. Hadad SM, Vaidya JS, Baker L, et al. Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis [J]. World J Surg, 2007, 31(6): 12981303.
7. 郭定刚, 陈福春, 邱振明. 腔镜胆囊切除术在坏疽性胆囊炎中的应用 [J]. 肝胆胰外科杂志, 2005, 17(3): 237238.
8. 张展志, 张能维, 朱斌, 等. 急性胆囊炎腹腔镜胆囊切除手术时机的再探讨 [J]. 安徽医药, 2010, 14(1): 5152.
9. 向国安, 陈开运, 肖方联, 等. 胆囊壶腹部结石嵌顿伴胆囊积液的腹腔镜胆囊切除术 [J]. 中国微创外科杂志, 2006, 6(3): 177179.
10. 邵天松, 伍冀湘, 梁杰雄, 等. 急性胆囊炎的腹腔镜手术治疗体会（附212例报告） [J]. 中国微创外科杂志, 2010, 10(9): 821823.
11. Bessa SS, AlFayoumi TA, Katri KM, et al. Clipless laparoscopic cholecystectomy by ultrasonic dissection [J]. J Laparoendosc Adv Surg Tech A, 2008, 18(4): 593598.
12. 马海, 沈文来, 李杨, 等. “三孔一勾到底法”腹腔镜胆囊切除术1 260例临床总结 [J]. 中国普外基础与临床杂志, 2009, 16(10): 800802.
13. 杨昌平, 郭海鹰, 刘强, 等. 无异物腹腔镜胆囊切除术的研究 [J]. 中华普外科手术学杂志（电子版）, 2010, 4(1): 6972.
14. Attwell A, Hawes R. Surgical clip migration and choledocholithiasis: a late, abrupt complication of laparoscopic cholecystectomy [J]. Dig Dis Sci, 2007, 52(9): 22542256.
15. Lee AY, Carter JJ, Hochberg MS, et al. The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital [J]. Am J Surg, 2008, 195(4): 467470.
16. 冯雪峰, 应福明. 腹腔镜治疗急性结石性胆囊炎的手术时机 [J]. 现代实用医学, 2008, 20(5): 352353, 361.
17. 高瑞岗, 李奎, 冯宝华, 等. 腹腔镜胆囊切除术治疗508例急性结石性胆囊炎的临床总结 [J]. 中国内镜杂志, 2008, 14(3): 322324, 329.
18. 刘晓辉, 谢开斌, 李桂良, 等. 胆囊管逆行分离法在急性胆囊炎LC中的应用 [J]. 肝胆外科杂志, 2009, 17(4): 298299.
19. 周骏, 冯来运, 许可, 等. 腹腔镜Hartmann袋切开法在困难胆囊手术中的应用 [J]. 中国普通外科杂志, 2009, 18(3): 306307.
20. 陈彦波, 吴唯. 腹腔镜胆囊大部分切除术临床应用探讨 [J]. 中国普通外科杂志, 2007, 16(2): 195196.
21. Tian Y, Wu SD, Su Y, et al. Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China [J]. Surg Today, 2009, 39(6): 510513.
22. Horiuchi A, Watanabe Y, Doi T, et al. Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions [J]. Surg Endosc, 2008, 22(12): 27202723.
23. 倪春华, 熊咏, 李寿柏, 等. 刮吸解剖法在急性胆囊炎腹腔镜胆囊切除术中的应用 [J]. 中国微创外科杂志, 2009, 9(5): 450452.
24. 朱宏毅, 季福, 孔卉玲. 腹腔镜胆囊切除中转开腹手术的危险因素分析 [J]. 中国普通外科杂志, 2009, 18(8): 787789.
25. 詹勇强, 王成友, 张敏杰, 等. 腹腔镜胆囊切除术适应证与并发症的探讨: 附3 002例报告 [J]. 中国普通外科杂志, 2009, 18(8): 797800.
26. Kanaan SA, Murayama KM, Merriam LT, et al. Risk factors for conversion of laparoscopic to open cholecystectomy [J]. J Surg Res, 2002, 106(1): 2024.
27. 李军, 张辉, 朱雷鸣, 等. 急性结石性胆囊炎行LC术难易程度的相关因素分析 [J]. 中国普通外科杂志, 2009, 18(8): 783785.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clipless Laparoscopic Cholecystectomy for Patients with Calculous Cholecystitis in Acute Inflammation Stage

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