Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator's aim during early laparoscopic cholecystectomy
Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator's aim during early laparoscopic cholecystectomy
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DOI：
10.1007/s00534-005-1062-4
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Wada, K
中科院分区：
文献类型：
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作者：
Toyota, N;Takada, T;Wada, K
1984年，Kozarek首次报道了使用内窥镜逆行胰胆管造影术（ERCP）进行胆囊管选择性插管，此后该手术也被其他人报道。通过这种方法，可以使用例如选择性细胞学详细检查胆囊中的疾病，还可以进行急性胆囊炎的引流。通过这种手术，我们能够成功地进行早期腹腔镜胆囊切除术（LC）。虽然手术往往是有问题的急性胆囊炎患者，因为炎症，使卡洛三角难以区分。在手术期间使用内窥镜鼻胆囊引流（ENGBD）使我们能够识别胆囊管以进行导管插管。我们对22例急性胆囊炎患者中的18例进行了早期LC，而同期18例患者接受了开腹胆囊切除术（回顾性研究）。然后将这两组进行比较。LC组术前、术后时间及住院时间明显短于LC组（P < 0.05）。ENGBD导致出血很少。ENGBD患者均不需要转为开放手术，而非ENGBD患者中有11.1%转为开放手术。ENGBD成功应用于18/22例（81.81%）患者。使用ENGBD联合LC的优点是：（i）即使患者有腹水，胆囊炎症也会减轻;（ii）使用ENGBD通常会改善可视化，并使胆囊管识别更容易。但是，如果无法进行ERCP，也必须排除ENGBD的性能。
In 1984, Kozarek first reported the use of endoscopic retrograde cholangiopancreatography (ERCP) to perform selective cannulation of the cystic duct, and since then this procedure has also been reported by others. With this procedure, disorders in the gallbladder can be examined in detail, using, for example, selective cytology, and drainage for acute cholecytitis can also be performed. With this procedure, we were able to successfully perform early laparoscopic cholecystectomy (LC). Although surgery is often problematic in patients with acute cholecystitis because of inflammation, making Callot's triangle difficult to distinguish. the use of endoscopic naso-gallbladder drainage (ENGBD) during surgery enables us to identify the cystic duct for catheter cannulation. We performed early LC for acute cholecystitis in 18 of 22 patients, while 18 other patients underwent open cholecystectomy during the same period (retrospective study). These two groups were then compared. The LC group had shorter pre- and postoperative periods and shorter hospitalization (P < 0.05). ENGBD resulted in very little bleeding. None of the ENGBD patients required conversion to open surgery, whereas 11.1% of the non-ENGBD patients were converted. ENGBD was successfully employed in 18 of the initial 22 (81.81%) patients. The favorable points in using ENGBD with LC were that (i) the gallbladder inflammation was alleviated even if patients had ascites, and (ii) use of ENGBD normally improved visualization and made cystic duct identification easier. However, if ERCP cannot be carried out, the performance of ENGBD must also be ruled out.