腹腔镜胆囊切除术治疗大/巨胆结石:病例报告及文献综述。

A. Shrestha, S. Bhattarai, S. Shrestha, M. Chand, A. Bhattarai
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In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. 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引用次数: 1

摘要

胆结石病(GSD)是最常见的胆道疾病。在尼泊尔,GSD是导致人们入院的常见外科问题之一。其患病率为4.87%。胆结石的大小很重要,因为巨大/较大的胆结石有较高的并发症风险,并且在腹腔镜胆囊切除术(LC)中存在技术困难。大多数巨大胆结石患者首选开腹胆囊切除术。随着经验丰富的腹腔镜外科医生和现代腹腔镜设备的可用性,LC在大/巨大胆结石中也是可行的。在这个病例报告中,我们报告了2例一个大的和一个巨大的胆结石,每个都成功地在腹腔镜下完成。病例1,51岁女性,有5个月的间歇性右上腹绞痛病史,与高脂肪食物有关,无明显的既往病史和手术史。腹部超声示胆囊正常,伴多发胆结石,最大约4cm。她计划当选立法会议员。延长脐下切口后取出胆囊。在切面上,我们发现多发胆结石,其中一颗较大的胆结石,尺寸为4*3.3* 3cm,重量为23.2 gm。病例2:一名39岁女性,已知在钙通道阻滞剂(CCB)和血管紧张素受体阻滞剂(ARBs)治疗下的高血压患者,有5个月的间歇性右上腹绞痛病史,与脂肪性食物有关,无明显手术史。腹部超声显示胆囊正常,伴一大块胆结石(约4.7厘米)。择期行胆囊切除术,延长脐下切口后取出胆囊。在切面上,我们发现一颗巨大的胆结石,尺寸为5* 3*2.8 cm,重量为24.7 gm。术后顺利。结论大/巨型胆结石并发症风险高,有症状和无症状患者均应行胆囊切除术。即使对于大/巨大的胆结石,LC似乎是开放胆囊切除术的首选治疗方法,应由经验丰富的腹腔镜外科医生进行,并考虑在无法暴露解剖结构和任何术中技术困难的情况下转换为开放的可能性。
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Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature.
Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.
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