胆嚢頸部嵌頓結石に対する腹腔鏡下胆嚢摘出術の検討

DOI 参考文献8件

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  • Laparoscopic cholecystectomy for the impacted gallstone

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Laparoscopic cholecystectomy is the procedure of choice for patients with cholecystolithiasis, but the risk factors and consequences of a failed attempt in patients with an impacted gallstone (IG) remain unknown. We analyzed technical aspects, efficacy, and complications of the laparoscopic approach in patients with IG versus non-impacted gallstone (NIG). Subjects were 167 patients who underwent a laparoscopic cholecystectomy at the hospital between 1996 and 2001. Twenty (12%)of these patients were diagnosed with having IG. Mean operation time for IG was longer than that for NIG (148.8±49.8 min, vs96.5±36.5min, p<0.05). Mean blood loss was significantly greater for IG than for NIG(144.5±151.4g vs31.5±120.6g, p<0.05). Five IG patients(25%) required conversion to open Surgery, while one NIG patient (0.7%) required it. Mean time for the conversion was 59±47.4min in the IG patients. In most of these cases, inflammatory changes or unclear anatomical findings during the operation led to technical difficulties that required conversion to open surgery, Complications of remnant gallstones were found in two patients (10%). In conclusion, laparoscopic cholecystectomy is possible in patients with IG. Inflammation around the cystic duct, however, is the prime determinant of conversion to open surgery. Early assessment of Calot's triangle will quickly determine the feasibility of laparoscopic cholecysytectomy without wasting the time and endangering the bile duct. Physicians should maintain a low threshold for conversion to the open procedure.

収録刊行物

  • Tando

    Tando 17 (2), 73-76, 2003

    Japan Biliary Association

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