The Clinical Analysis Of Laparoscopic Subtotal Cholecystectomy In Patients With Gallstone Cholecystitis With Difficulty In Safe Dissection

Objective: Collecting the clinical data of the group patients who underwent open subtotal cholecystectomy,the group patients who underwent laparoscopic subtotal cholecystectomy and the group patients who underwent conversion to open cholecystectomy due to the judgement of difficult and unsafe dissection.with the comparison of these groups perioperative data and collection of postoperative follow-up data of the patients who underwent subtotal cholecystectomy,discuss the safety and feasibility of laparoscopic subtotal cholecystectomy(LSC).Methods: Selecting the Calculous cholecystitis patients of the General Surgery from January 2013 to December 2017 at Shengjing Hospital of China Medical University,they were judged difficult and unsafe dissection during the operation by the Associate professor or above.Exculde the patients of who were confirmed to have choledocholithiasis or choledochotomy in the removal procedure;Intraoperative frozen or postoperative pathology revealed cholecystic malignant lesions,the patients who were suspected gallbladder malignancy by Preoperative examination,the patients who were confirmed Noncalculous cholecystitis in the operation.The results were compared with three groups of preoperative,intraoperative and postoperative data.collect the postoperative follow-up data of the patients who underwent subtotal cholecystectomyResults:Comparing 16 patients in the group of OSC,23 patients in the group of LSC and 44 patients in the group of LC-OC finally,there was no statistically significant difference between the three groups of age,gallbladder wall thickness,Preoperative biochemical examination,such as AST,ALT,TBIL.with the Relative value was[62.8±11.6、61.6±14.8、57.0±11.4,P=0.171;7.31±4.27、5.30±2.14、6.70±2.65,P=0.76;67.9±98.8、100.2±122.8、58.8±97.3,P=0.310;55.1±73.4、69.0±66.5、60.3±107.1,P=0.886;21.7±19.0、25.5±25.8、22.7±23.3,P=0.853]respectively.whether combine with MIRIZZI’s syndrome,gallbladder shrinkage,Postoperative bile leakage,or Postoperative fever were also compared,the P value was 0.181、0.123、0.399、0.628 respectively.four patients occurred Bile duct injury,one Liver damage bed,one Abdominal abscess,one Postoperative intestinal obstruction in the group of LC-OC,there is no Similar cases in the group of SC,OSC and LSC were included.six patients occurred Infection of incision,one Transferred to the ICU during postoperative.one patient occurred Infection of incision,one Postoperative abdominal hemorrhage,one ransferred to the ICU during postoperative in the group of OSC,but no similar cases in the group of LSC.when compare the date Infection of incision between the TC and SC,P=0.07.The operation time,intraoperative bleeding,Postoperative exhaust,of No conversion to open surgery was required in both groups.The operation time,postoperative exhaust time,postoperative hospital stay data between these groups was[141.0±47.2、179.2±67.8、159.7±46.9,P=0.078;49.6±47.0、109.4±103.6、150.5±128.0,P=0.002;2.26±0.62、3.94±1.39、3.89±1.13,P=0.001;6.83±4.01、11.00±2.70、11.86±7.11,P=0.004].Postoperative pathological diagnosises in each group prompt that Chronic cholecystitis accounted for the largest,followed by Chronic cholecystitis acute attack,and acute cholecystitis Accounted for at least.Telephone follow-up was performed on all patients with subtotal cholecystectomy.Among them,7 were lost to follow-up.The rate of lost follow-up was 17.9%.Follow-up time was 2-61 months.Three patients had a feeling of fullness after eating,one had occasional steatorrhea,one patient complained of occasional pain on the upper abdomen,and self-administered omeprazole and other stomach medicines were available.One case of residual stones in the common bile duct was found 2 months after surgery,removal by residual gallbladder T drainage tube.the patient was discharged from the hospital.There was no residual gallstone,no residual mucosal lesions.Conclusion:Under the circumstance when difficulty in safe anatomy in the operation of calculous cholecystitis,LSC is safe and feasible compared with the operation of LC and OSC,and has the advantages of minor injury,fewer complications,less trauma and quicker recovery.