Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHANG Peizhong , MIAO Jianjun , LI Xiaowu , LIU Bing , WANG Jin , Lü Ruichang , ZHANG Jinjiang , CAI Dawei , ZHAO Weinan , ZHANG Jie

Department of General Surgery, The 251st Hospital of PLA, Zhangjiakou, Hebei 075000, P. R. China;

Corresponding?author：

SHANG Peizhong, Email: spz251@163.com

Keywords：

cholecystitis; cholecystolithiasis; cholecystectomy; laparoscope; bile duct injury; ampulla localization on an imaginary clock

DOI：

10.7507/1007-9424.201902057

Video：

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Objective To explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.Methods A retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.Results There were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).Conclusion This study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.

Citation： SHANG Peizhong, MIAO Jianjun, LI Xiaowu, LIU Bing, WANG Jin, Lü Ruichang, ZHANG Jinjiang, CAI Dawei, ZHAO Weinan, ZHANG Jie. Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 792-797. doi: 10.7507/1007-9424.201902057 Copy

1.	尚東, 張慶凱. 腹腔鏡膽囊切除術膽管損傷的預防. 中華普通外科雜志, 2017, 32(8): 654-657.
2.	Hariharan D, Psaltis E, Scholefield JH, et al. Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg, 2017, 41(1): 90-99.
3.	李相成, 江王杰. 醫源性膽管損傷分型及其意義. 中國實用外科雜志, 2018, 38(9): 985-988.
4.	劉希寧, 李英俊, 張瑞波, 等. 腹腔鏡膽囊切除術中膽管損傷的處理方法探討. 中華普通外科學文獻(電子版), 2018, 12(6): 397-399, 404.
5.	Barrett M, Asbun HJ, Chien HL, et al. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc, 2018, 32(4): 1683-1688.
6.	王紅偉, 劉江偉, 康燕, 等. 微創保膽治療1 008例膽囊息肉的臨床及病理分析. 中國普外基礎與臨床雜志, 2018, 25(9): 1065-1070.
7.	尚培中. 膽囊結石腹腔鏡治療今日觀. 解放軍醫藥雜志, 2015, 27(11): 1-5.
8.	尚培中. 腹腔鏡膽囊切除術中膽囊壺腹鐘表定位法的研究及應用分析. 人民軍醫, 2017, 60(11): 1088-1091.
9.	尚培中. 膽囊壺腹鐘表定位法對保障腹腔鏡膽囊切除安全性的指導意義. 中華普外科手術學雜志(電子版), 2018, 12(1): 15-20.
10.	尚培中, 李曉武, 苗建軍, 等. 應用壺腹鐘表定位法縮短腹腔鏡膽囊切除術學習曲線. 腹腔鏡外科雜志, 2018, 23(7): 481-485.
11.	Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 73-86.
12.	項建斌. 早期腹腔鏡膽囊切除術治療輕中型急性膽囊炎的臨床研究. 中華普外科手術學雜志(電子版), 2019, 13(1): 54-56.
13.	彭一峰, 莫曄, 陳國斌, 等. 腹腔鏡膽囊動脈入路與傳統入路膽囊切除術的對比分析. 中華普外科手術學雜志(電子版), 2018, 12(2): 152-154.
14.	齊敦峰, 張昕輝, 李歡送, 等. 腹腔鏡下左側入路膽囊切除術在急性膽囊炎患者中的應用. 中國普外基礎與臨床雜志, 2017, 24(12): 1492-1495.
15.	李曉東, 劉山, 鄭本波. 4種解剖標志幫助識別膽囊管避免膽管損傷(附316例報道). 中國普外基礎與臨床雜志, 2018, 25(9): 1121-1123.
16.	戴海粟, 陳志宇. 肝門部解剖變異與腹腔鏡膽囊切除術中膽管損傷. 中華普通外科雜志, 2017, 32(8): 661-664.
17.	王蔚藍, 吳偉, 呂永峰, 等. 腹腔鏡膽囊切除術中變異膽囊動脈出血的預防與處理. 中國微創外科雜志, 2014, 14(6): 551-552.
18.	閆志文, 閆文舉. 腹腔鏡膽囊切除術中膽囊動脈出血的原因及防治措施. 醫藥論壇雜志, 2014, 35(12): 104-105.
19.	黃鑫, 洪建文, 詹澤鋒, 等. 腹腔鏡膽囊切除術中轉開腹30例臨床分析. 中華肝臟外科手術學電子雜志, 2014, 3(5): 276-278.
20.	孟凡盛, 龐晨, 高原, 等. 膽囊管和膽囊動脈的變異分型及影像輔助檢查. 世界最新醫學信息文摘(電子版), 2017, 17(99): 203-204.
21.	趙曉剛, 王德貴. 腹腔鏡膽囊切除術中膽囊動脈的解剖觀察. 臨床醫學研究與實踐, 2016, 1(14): 89.
22.	Kunasani R, Kohli H. Significance of the cystic node in preventing major bile duct injuries during laparoscopic cholecystectomy: a technical marker. J Laparoendosc Adv Surg Tech A, 2003, 13(5): 321-323.
23.	張偉耀, 饒智, 潘磊. 膽囊淋巴結在腹腔鏡膽囊切除術中的定位標志作用初探. 中國普外基礎與臨床雜志, 2014, 21(9): 1134-1137.
24.	哈恒勇, 陳文學, 李富榮. 腹腔鏡" 一鉤到底法”快速膽囊切除術的臨床應用研究. 中華普通外科學文獻(電子版), 2015, 9(4): 304-306.
25.	Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy—" Fenestrating” vs " Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg, 2016, 222(1): 89-96.
26.	Stefanidis D, Chintalapudi N, Anderson-Montoya B, et al. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc, 2017, 31(1): 142-146.

1. 尚東, 張慶凱. 腹腔鏡膽囊切除術膽管損傷的預防. 中華普通外科雜志, 2017, 32(8): 654-657.
2. Hariharan D, Psaltis E, Scholefield JH, et al. Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg, 2017, 41(1): 90-99.
3. 李相成, 江王杰. 醫源性膽管損傷分型及其意義. 中國實用外科雜志, 2018, 38(9): 985-988.
4. 劉希寧, 李英俊, 張瑞波, 等. 腹腔鏡膽囊切除術中膽管損傷的處理方法探討. 中華普通外科學文獻(電子版), 2018, 12(6): 397-399, 404.
5. Barrett M, Asbun HJ, Chien HL, et al. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc, 2018, 32(4): 1683-1688.
6. 王紅偉, 劉江偉, 康燕, 等. 微創保膽治療1 008例膽囊息肉的臨床及病理分析. 中國普外基礎與臨床雜志, 2018, 25(9): 1065-1070.
7. 尚培中. 膽囊結石腹腔鏡治療今日觀. 解放軍醫藥雜志, 2015, 27(11): 1-5.
8. 尚培中. 腹腔鏡膽囊切除術中膽囊壺腹鐘表定位法的研究及應用分析. 人民軍醫, 2017, 60(11): 1088-1091.
9. 尚培中. 膽囊壺腹鐘表定位法對保障腹腔鏡膽囊切除安全性的指導意義. 中華普外科手術學雜志(電子版), 2018, 12(1): 15-20.
10. 尚培中, 李曉武, 苗建軍, 等. 應用壺腹鐘表定位法縮短腹腔鏡膽囊切除術學習曲線. 腹腔鏡外科雜志, 2018, 23(7): 481-485.
11. Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 73-86.
12. 項建斌. 早期腹腔鏡膽囊切除術治療輕中型急性膽囊炎的臨床研究. 中華普外科手術學雜志(電子版), 2019, 13(1): 54-56.
13. 彭一峰, 莫曄, 陳國斌, 等. 腹腔鏡膽囊動脈入路與傳統入路膽囊切除術的對比分析. 中華普外科手術學雜志(電子版), 2018, 12(2): 152-154.
14. 齊敦峰, 張昕輝, 李歡送, 等. 腹腔鏡下左側入路膽囊切除術在急性膽囊炎患者中的應用. 中國普外基礎與臨床雜志, 2017, 24(12): 1492-1495.
15. 李曉東, 劉山, 鄭本波. 4種解剖標志幫助識別膽囊管避免膽管損傷(附316例報道). 中國普外基礎與臨床雜志, 2018, 25(9): 1121-1123.
16. 戴海粟, 陳志宇. 肝門部解剖變異與腹腔鏡膽囊切除術中膽管損傷. 中華普通外科雜志, 2017, 32(8): 661-664.
17. 王蔚藍, 吳偉, 呂永峰, 等. 腹腔鏡膽囊切除術中變異膽囊動脈出血的預防與處理. 中國微創外科雜志, 2014, 14(6): 551-552.
18. 閆志文, 閆文舉. 腹腔鏡膽囊切除術中膽囊動脈出血的原因及防治措施. 醫藥論壇雜志, 2014, 35(12): 104-105.
19. 黃鑫, 洪建文, 詹澤鋒, 等. 腹腔鏡膽囊切除術中轉開腹30例臨床分析. 中華肝臟外科手術學電子雜志, 2014, 3(5): 276-278.
20. 孟凡盛, 龐晨, 高原, 等. 膽囊管和膽囊動脈的變異分型及影像輔助檢查. 世界最新醫學信息文摘(電子版), 2017, 17(99): 203-204.
21. 趙曉剛, 王德貴. 腹腔鏡膽囊切除術中膽囊動脈的解剖觀察. 臨床醫學研究與實踐, 2016, 1(14): 89.
22. Kunasani R, Kohli H. Significance of the cystic node in preventing major bile duct injuries during laparoscopic cholecystectomy: a technical marker. J Laparoendosc Adv Surg Tech A, 2003, 13(5): 321-323.
23. 張偉耀, 饒智, 潘磊. 膽囊淋巴結在腹腔鏡膽囊切除術中的定位標志作用初探. 中國普外基礎與臨床雜志, 2014, 21(9): 1134-1137.
24. 哈恒勇, 陳文學, 李富榮. 腹腔鏡" 一鉤到底法”快速膽囊切除術的臨床應用研究. 中華普通外科學文獻(電子版), 2015, 9(4): 304-306.
25. Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy—" Fenestrating” vs " Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg, 2016, 222(1): 89-96.
26. Stefanidis D, Chintalapudi N, Anderson-Montoya B, et al. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc, 2017, 31(1): 142-146.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis

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