Feasibility study of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LI Furong , NIU Fuyong

Department of Hepatobiliary Surgery, The First Hospital of Yulin, Yulin, Shaanxi 719000, P.R.China;

Corresponding author：

LI Furong, Email: lifurong1983a@163.com

Keywords：

acute cholecystitis; single incision; three incisions; laparoscopic cholecystectomy; effectiveness

DOI：

10.7507/1007-9424.201612050

Video：

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Objective To explore the feasibility of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis, and to provide evidence based medicine for clinical treatment. Methods A total of 160 cases of acute cholecystitis who received treatment in our hospital from Jan. 2012 to Dec. 2015 were randomly divided into single incision group (n=80, received single incision laparoscopic cholecystectomy) and three incisions group (n=80, received three incisions laparoscopic cholecystectomy). The clinical and laboratory indexes were compared between the 2 groups. Results Compared with the three incisions group, there were statistically significant differences in the operation time, incision pain score, and subjective satisfaction, which were better in single incision group (P<0.05). But there was no significant difference in the blood loss, bed time, anal exhaust time, recovery time of intestinal peristalsis, hospitalization time, incidence of complication (including abdominal infection, bile duct injury, biliary fistula, and incision infection), ratios of T cell subsets (including CD3, CD4, and CD8 T cell), levels of immunoglobulin (including IgA, IgG, and IgM), and level of C reactive protein (P>0.05). Conclusions The effectiveness of single incision laparoscopic cholecystectomy is as good as three incisions laparoscopic cholecystectomy, but this single incision laparoscopic surgery is difficult, and its indications should be cautious. Single incision laparoscopic cholecystectomy is more suitable for patients undergoing elective cholecystectomy.

Citation： LI Furong, NIU Fuyong. Feasibility study of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(6): 722-726. doi: 10.7507/1007-9424.201612050 Copy

1.	刘鲁荣, 韩明子. 超声引导下胆囊穿刺术治疗急性胆囊炎概述. 中华临床医师杂志(电子版), 2016, 1(11): 308-309.
2.	刘鹏, 袁伟升, 宫琳, 等. 经皮经肝胆囊穿刺置管引流治疗高龄危重急性胆囊炎. 实用医药杂志, 2016, 33(5): 407-409.
3.	Cao AM, Eslick GD, Nagaraja V, et al. Erratum to: early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc, 2016, 30(3): 1183.
4.	Cox TC, Huntington CR, Blair LJ, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1 999 pregnant patients. Surg Endosc, 2016, 30(2): 593-602.
5.	Murata A, Okamoto K, Muramatsu K, et al. Effects of additional laparoscopic cholecystectomy on outcomes of laparoscopic gastrectomy in patients with gastric cancer based on a national administrative database. J Surg Res, 2014, 186(1): 157-163.
6.	麻忠武, 陈峰, 徐迈宇, 等. 经脐单孔与三孔法腹腔镜胆囊、阑尾联合切除的对比研究. 中国微创外科杂志, 2014, 14(10): 900-902.
7.	中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南 (2011 版). 中华消化外科杂志, 2011, 10(1): 9-13.
8.	Sato N, Kohi S, Tamura T, et al. Single-incision laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study of 52 consecutive patients. Int J Surg, 2015, 17: 48-53.
9.	Chuang SH, Chen PH, Chang CM, et al. Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis. World J Gastroenterol, 2013, 19(43): 7743-7750.
10.	Avery KN, Metcalfe C, Nicklin J, et al. Satisfaction with care: an independent outcome measure in surgical oncology. Ann Surg Oncol, 2006, 13(6): 817-822.
11.	Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy. Br J Surg, 1997, 84(5): 695.
12.	张忠涛, 韩威, 李建设, 等. 经脐单孔腹腔镜胆囊切除术 1 例报告. 腹腔镜外科杂志, 2008, 13(4): 314.
13.	许军, 赵磊, 徐力善, 等. 不同器械经脐单切口与三孔腹腔镜胆囊切除术的前瞻性随机对照研究. 中国微创外科杂志, 2014, 20(1): 38-42.
14.	宋洪亮, 贺亚东, 金肖丹, 等. 腹腔镜逆行胆囊切除术 30 例临床分析. 肝胆胰外科杂志, 2008, 20(4): 279-280.
15.	Ridker PM. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. Curr Atheroscler Rep, 2009, 359(4): 534-544.
16.	Tinhofer I, Weiss L, Gassner F, et al. Difference in the relative distribution of CD4⁺ T-cell subsets in B-CLL with mutated and unmutated immunoglobulin (Ig) VH genes: implication for the course of disease. J Immunother, 2009, 32(3): 302-309.
17.	杨爱国, 聂凯, 邹耀祥. 胆囊三角区炎症致密粘连时腹腔镜切除胆囊方法的探讨. 腹部外科, 2008, 21(4): 233-234.
18.	成陕林, 胡娟娟, 王新民. 腹腔镜及开腹手术对胆囊切除后患者肠粘连的临床疗效比较. 中国医药导报, 2015, 12(3): 81-84.
19.	丛守会. 腹腔镜手术治疗急性胆囊炎的临床体会 (附 47 例报告). 腹腔镜外科杂志, 2016, 21(6): 447-449.
20.	Boyd B, Lee ER. Ultrasound of the gallbladder and biliary tree : back to basics. Ultrasound Clin, 2014, 9(4): 567-586.
21.	Colak Y, Bozbey G, Erim T, et al. Impaired gallbladder motility and increased gallbladder wall thickness in patients with nonalcoholic fatty liver disease. J Neurogastroenterol Motil, 2016, 22(3): 470-476.
22.	Motla M, Manaktala S, Gupta V, et al. Sonographic evidence of ascites, pleura-pericardial effusion and gallbladder wall edema for dengue fever. Prehosp Disaster Med, 2011, 26(5): 335-341.
23.	Mohammadi A, Ghasemirad M, Mohammadifar M. Differentiation of benign from malignant induced ascites by measuring gallbladder wall thickness. Maedica (Buchar), 2011, 6(4): 282-286.
24.	Shingu Y, Komatsu S, Norimizu S, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc, 2016, 30(2): 526-531.
25.	Pietrabissa A, Pugliese L, Vinci A, et al. Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc, 2016, 30(7): 3089-3097.

1. 刘鲁荣, 韩明子. 超声引导下胆囊穿刺术治疗急性胆囊炎概述. 中华临床医师杂志(电子版), 2016, 1(11): 308-309.
2. 刘鹏, 袁伟升, 宫琳, 等. 经皮经肝胆囊穿刺置管引流治疗高龄危重急性胆囊炎. 实用医药杂志, 2016, 33(5): 407-409.
3. Cao AM, Eslick GD, Nagaraja V, et al. Erratum to: early laparoscopic cholecystectomy is superior to delayed acute cholecystitis: a meta-analysis of case-control studies. Surg Endosc, 2016, 30(3): 1183.
4. Cox TC, Huntington CR, Blair LJ, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1 999 pregnant patients. Surg Endosc, 2016, 30(2): 593-602.
5. Murata A, Okamoto K, Muramatsu K, et al. Effects of additional laparoscopic cholecystectomy on outcomes of laparoscopic gastrectomy in patients with gastric cancer based on a national administrative database. J Surg Res, 2014, 186(1): 157-163.
6. 麻忠武, 陈峰, 徐迈宇, 等. 经脐单孔与三孔法腹腔镜胆囊、阑尾联合切除的对比研究. 中国微创外科杂志, 2014, 14(10): 900-902.
7. 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南 (2011 版). 中华消化外科杂志, 2011, 10(1): 9-13.
8. Sato N, Kohi S, Tamura T, et al. Single-incision laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study of 52 consecutive patients. Int J Surg, 2015, 17: 48-53.
9. Chuang SH, Chen PH, Chang CM, et al. Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis. World J Gastroenterol, 2013, 19(43): 7743-7750.
10. Avery KN, Metcalfe C, Nicklin J, et al. Satisfaction with care: an independent outcome measure in surgical oncology. Ann Surg Oncol, 2006, 13(6): 817-822.
11. Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy. Br J Surg, 1997, 84(5): 695.
12. 张忠涛, 韩威, 李建设, 等. 经脐单孔腹腔镜胆囊切除术 1 例报告. 腹腔镜外科杂志, 2008, 13(4): 314.
13. 许军, 赵磊, 徐力善, 等. 不同器械经脐单切口与三孔腹腔镜胆囊切除术的前瞻性随机对照研究. 中国微创外科杂志, 2014, 20(1): 38-42.
14. 宋洪亮, 贺亚东, 金肖丹, 等. 腹腔镜逆行胆囊切除术 30 例临床分析. 肝胆胰外科杂志, 2008, 20(4): 279-280.
15. Ridker PM. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. Curr Atheroscler Rep, 2009, 359(4): 534-544.
16. Tinhofer I, Weiss L, Gassner F, et al. Difference in the relative distribution of CD4⁺ T-cell subsets in B-CLL with mutated and unmutated immunoglobulin (Ig) VH genes: implication for the course of disease. J Immunother, 2009, 32(3): 302-309.
17. 杨爱国, 聂凯, 邹耀祥. 胆囊三角区炎症致密粘连时腹腔镜切除胆囊方法的探讨. 腹部外科, 2008, 21(4): 233-234.
18. 成陕林, 胡娟娟, 王新民. 腹腔镜及开腹手术对胆囊切除后患者肠粘连的临床疗效比较. 中国医药导报, 2015, 12(3): 81-84.
19. 丛守会. 腹腔镜手术治疗急性胆囊炎的临床体会 (附 47 例报告). 腹腔镜外科杂志, 2016, 21(6): 447-449.
20. Boyd B, Lee ER. Ultrasound of the gallbladder and biliary tree : back to basics. Ultrasound Clin, 2014, 9(4): 567-586.
21. Colak Y, Bozbey G, Erim T, et al. Impaired gallbladder motility and increased gallbladder wall thickness in patients with nonalcoholic fatty liver disease. J Neurogastroenterol Motil, 2016, 22(3): 470-476.
22. Motla M, Manaktala S, Gupta V, et al. Sonographic evidence of ascites, pleura-pericardial effusion and gallbladder wall edema for dengue fever. Prehosp Disaster Med, 2011, 26(5): 335-341.
23. Mohammadi A, Ghasemirad M, Mohammadifar M. Differentiation of benign from malignant induced ascites by measuring gallbladder wall thickness. Maedica (Buchar), 2011, 6(4): 282-286.
24. Shingu Y, Komatsu S, Norimizu S, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc, 2016, 30(2): 526-531.
25. Pietrabissa A, Pugliese L, Vinci A, et al. Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc, 2016, 30(7): 3089-3097.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Feasibility study of single incision laparoscopic cholecystectomy in the treatment of acute cholecystitis

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