.". 2546 - 2548
Laparoscopic Cholecystectomy in Phichit Hospital In 2003 - 2005
..*
* 7
!"#$%&'%()
*+,--'.,,%", elective case ( 7 %8 .. 2546 ) ..
2548 -+%* , 214 @ 61 (7 28.50) D 153 (7 71.50) , -- "#$%-'.,",,%%F-G,@
(Open cholecystectomy) +% 114 (7 53.27) "#$%-'.,",,%%F-O (Laparoscopic cholecystectomy) +% 100 (7 46.73) %77%(",,%%F-G,@
%F-O 85.65 -, 88.42 - +, +%%
",,%%F-G,@%%F-O, S-' 8.05 %, 3.53 % +, -"#$% 1 O-@-%T'-U%7 Acute Myocardial Infraction U ", &,!"#$%
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Abstract
A retrospective study of patients elective case who were diagnosed as gall stone and treatment by surgery in Phichit hospital during 2003 to 2005.
Total number of patients were 214. Number of male patients were 61 (28.50%), female patients 153 (71.50%). First group 114 patients (53.27%) were treated by open cholecystectomy and second group 100 patients (46.73%) were treated by laparoscopic cholecystectomy. To compare open cholecystectomy
with laparoscopic cholecystectomy. The result, operation time of open cholecystectomy and laparoscopic cholecystectomy were 85.65 min., 88.42 min., respectively. Post operation stay was shorter in laparoscopic cholecystectomy. (3.53 vs 8.05) One patient died because of acute myocardial infraction on post operation. Total mortality rate were 0.47%, complication of open cholecystectomy and laparoscopic cholecystectomy were 3.27%, 4.21%, respectively.
There were 10 patients (4.67%) failed laparoscopic cholecystectomy conversion to open cholecystectomy.
In conclusion : there is an increasing trend in laparoscopic cholecystectomy recently, because of smaller surgical wound, less operative pain, shorter post operation stay, and cosmetic better than open cholecystectomy.
'%()*+,- (&.7 70 mixed gall stone 1,2 h 7 % D : @ 1.5 : 1 -'7h 50 8 !*. 1 7 O)7.-%'!* T' 7&%#-.7%
'!* 2
i,'%()*+,-1,2 ., )*+,- OT'O)U, h ', D
%@, @%7%%7%, %,
,T,,+%, &@, @ &
T,],T,, , .,@,j
@ O
7 50 - 90 !"#$%'%()*+,- .- 2 (asymptomatic gallstones ) ,
% 20 8 ("#$%-* % 2 ( 3 &.- 3 7'%-'( ,(symptomatic gallstones) 7 1 - 3 8 O7O.O*@-%1,3 -',., T, (dyspepsia) ,S7 7 -.!O#7T*O% 30 - 60
- 1,2 %,(@&!% %,O-,
biliary colic %,,%% 3 @..4 % symptomatic gallstones -O complicated gallstones @ Acute cholecystitis 7h7 3 - 5 83 ,7-&T'.O- -.! ,]
(@&!%!h7-'"#$% (!]-' (Murphyms sign)1,2,5 %,+\%,
%F- standard -',--'O,7+., &)#
.,'%. 7-&%+O#%7 95 O+ '%-'-!,( D% 2 .. 1,3,6
'%()*+,--'- &T , )*+,-7",- 2 %F-1,7,8,9&T
1. %F-G,@ (open cholecystectomy : OC)
2. %F-O (laparoscopic cholecystectomy : LC )
O+&D!",%%7U(
(access) -',- \'"#$%7.,"7!,
!"-'G,., 7 &%]%, @ (numbness) ]O-%T')#O"O , incisional hernia 7
" ,* +( "", ]-'O,-'7+.,,.,"7@ !
",,-' -% ! minimal access surgery (MAS)7,8,10 \'%
",,%F-OO% '! MAS -'- q ( -,"]-'O, 10
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v'O@T' Phillippe Mouret .,", LC 7-''%%&-'", LC O+]4,6,7,9,10 7., %,]% * (O w 7'% i", ,%%F- LC -'% gold standard operation ,U7-7OFUO+ symtompmatic
gall stone3,6,12 O%(7.-",,%F- LC O+]&*T' 13 & ..2534 -'
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2. "#$%-''%)*+,-@,-'.- (asymptomatic gallstones) ",q&%
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%%7
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Absolute Contraindication 7,10,11,16
Severe cardiopulmonaly, Coagulopathy, Abdominal malignancy, Peritonitis % Cholangitis, Hypovolumic shock
Relative Contraindication 7,10,11,16
Common bile duct (CBD) stone % complication, Pregnancy, Acute cholecystitis, Severe or uncontrolled portal hypertension, Previous abdominal operation, Morbid, obesity, Sepsis O T', Intestinal obstruction, Inability to tolerate general anesthesia, Generalized peritonitis, biliary fistula, &%@+D!
-*T')%F-&'%
()*+,- ,S7--"", ,%%F-G,@%F-O(T' U%7\!", 77% ", 7 +%% ",
,]!#
"#$%&'%()*+,--'.,,%", elective case , (
q7%""#$%( 7 %8 .. 2546 o 2548 \' )7!*#,!
!.!7 * , 214 % +%&7 %"#$%-'.,",,%%F- G,@ +% 114 7,%%F-O +% 100 .,!#(, O+&D &7+% T&% "
% @,!", FOU-'", 7 &S-'!
U%7\ 77%", 7+%%
",
0 10 20 30 40 50 60
48 36 30
26 32 42
2546 2547 2548
!"#!#$#%&!'"" elective case )")*&
+,-%'+.%#&!'&% / ).0.2546 - 2548 !'1 1 1 '.* !"#%&!!.+
)23 #%&!%* 214 4 !"#%&!+,-% 114 '
+.%# 100 '#& )0 '+#%&! !& 1
1 O,!# 7%F-",
!#T*w +%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 1.
@ D
61 (28.50) 153 (71.50)
35 (16.35) 79 (36.92)
26 (12.15) 74 (34.58)
% 214 (100) 114 (53.27) 100 (46.73)
2. (8)
% 20 3 (1.40) 2 (0.93) 1 (0.47)
21-30 9 (4.21) 4 (1.87) 5 (2.34)
31-40 30 (14.02) 10 (4.67) 20 (9.35) 41-50 41 (19.16) 18 (8.41) 23 (10.75) 51-60 41 (19.16) 20 (9.35) 21 (9.81)
!#T*w +%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 61-70 49 (22.90) 32 (14.95) 17 (7.94) 71-80 33 (15.42) 22 (10.28) 11 (5.14)
81-90 6 (2.80) 5 (2.34) 1 (0.47)
91 8 !*. 2 (0.93) 1 (0.47) 1 (0.47)
% 214 (100) 114 (53.27) 100 (46.73)
S-' 55.17 57.64 52.35
*##05#$* 214 )"%4- 61 ( 28.50) 46 153 ( 71.50) 4- : 6%#!" 1 : 2.5 &!'&% 17 o 96 / 7 55.17 / !"#%&!+,-%
* 114 ( 53.27) '+#.%# * 100 ( 46.73) #.!6 )"2 '% #*8"&- 91-% 37 - 37.5 0::. ( 79.44)
*&!2% (underlying disease) 2 O,&7+% T&%!"#$% (underlying disease)
&
underlying disease
+%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 1. Cardiovascular
- Hypertension 27 (41.54) 15 (23.08) 12 (18.46) - Ischemic heart disease 5 (7.69) 3 (4.62) 2 (3.08) - Atial Fibbillation 2 (3.08) 0 2 (3.08) - Dyslipidemia 5 (7.69) 3 (4.62) 2 (3.08) 2. Respiratory
- Asthma 1 (1.54) 1 (1.54) 0
- Chronic obstructive pulmonary disease
4 (6.15) 3 (4.62) 1 (1.54) 3. Renal Failure 2 (3.08) 1 (1.54) 1 (1.54)
&
underlying disease
+%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 4. Hematologic disease
- Thalassemia 5 (7.69) 3 (4.62) 2 (3.08) 5. Other
- Diabetis Millitus 10 (15.38) 5 (7.69) 5 (7.69)
- Cirrhosis 2 (3.08) 2 (3.08) 0
- Steroid abused 1 (1.54) 1(1.54) 0
- Gout 1 (1.54) 0 1 (1.54)
% 65 (100) 37 (56.92) 28 (43.08)
%&-'"#$%-'O,&T &&%, O# 7 41.54 & % 715.38 7&
.!(T,O#7 7.69 \'--&,-% -% &
"% 7FOU-'", 3 O,"%
ABC '+O, O#O, x
WBC count (cells/mm.3 ) 1,500 34,800 10,871
Neutrophil (%) 18 96 64.21
Total billirubin (mg/dl) 0.20 22 1.93 Direct billirubin (mg/dl) 0.01 11.23 0.77 Alkaline phosphatate (u/l) 20 1,735 233.48
4 O,FOU-'",
FOU-'", +%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 1. Single gallstone 129 (60.28) 70 (32.71) 59 (27.57) 2. Multiple gallstone 85 (39.72) 44 (20.56) 41 (19.16) 3. Common bile duct stone 30 (14.01) 30 (14.01) 0 4. Common bile duct dilated 52 (24.30) 47 (21.96) 5 (2.34) 5. Intrahepatic duct stone 5 (2.34) 5 (2.34) 0 6. Acute cholecystitis 31 (14.48) 25 (11.68) 6 (2.80) 7. Chronic cholecystitis 136 (63.55) 73 (34.11) 63 (29.44) 8. Gallbladder polype 3 (1.40) 0 3 (1.40) 9. Empyema gallbladder 7 (3.27) 5 (2.34) 2 (0.93) 10. Distal CBD mass 2 (0.93) 2 (0.93) 0 11. Cholecystoenteric fistula 1 (0.47) 1 (0.47) 0 12 Acalculous cholecystitis 2 (0.93) 2 (0.93) 0 : "#$%FOU%% '
",%"#$%O%( D'% Single gallstone 129 (7 60.28) -+%],T,
!%!*S-' 10,871 cells/mm.3 (-'-],T,!%!*O#7% Empyema gallbladder %,% O%
Total 7 Direct billirubin !*S-' 1.93 mg/dl, 0.77 mg/dl +, (-'- Direct billirubin 7 Alkaline phosphatate !*O#%- Common bile duct stone %,%
O,--"#$%-'.,",'%()*+,-*O%F-
1. 77%!",7+%% ",*O%F-
5 O,77%!",7+%% ", 1. 77%!",
(-)
+% (7) open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 30 o 60 74 (34.57) 46 (21.49) 28 (13.08) 61 o 90 70 (32.71) 29 (13.55) 41 (19.16) 91 o 120 38 (17.76) 20 (9.35) 18 (8.41)
121 o 150 20 (9.35) 12 (5.61) 8 (3.74)
% 150 12 (5.61) 7 (3.27) 5 (2.34)
% 214 (100) 114 (53.27) 100 (46.73)
%%S-' 86.94 85.65 88.42
2. +%%
", (%)
+% (7) open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7)
", * 7 (3.27) 0 7 (3.27)
1 o 5 120 (56.07) 47 (21.96) 73 (34.11)
6 o 10 65 (30.38) 45 (21.03) 20 (9.35)
11 o 15 18 (8.42) 18 (8.42) 0
16 o 20 0 0 0
21 o 25 2 (0.93) 2 (0.93) 0
26 o 30 0 0 0
% 30 2 (0.93) 2 (0.93) 0
% 214 (100) 114 (53.27) 100 (46.73)
+%%S-' 5.94 8.05 3.53
* &T"#$%.,", Ambulatory Laparoscopic cholecystectomy
%77%-'(@(",,%%F-G,@%F-O,S-' 85.65 - (1.43 @..), 88.42 - (1.47 @..) +, +%% ",,%%F-G,@%%F-O,
S-' 8.05 % 7 3.53 % +, -"#$% 10 (7 4.67) -'",,%%F-O% % -'%F-G,@ \'-O ,-* 1) severe adhesion 6 +( identified cystic duct ., 2) empyema gallbladder 2 T' gallbladder -U%7O gallbladder wall 7 7- adhesion +(
7 identified 3) long cystic duct 1 T'!h7", identified .,.@,7OO%- CBD injury G,@.%- CBD injury (, 4) cholecystoenteric fistula 1
U%7\",
6 O,U%7\",*O%F- Complication +%
(7)
open cholecystectomy +% (7)
laparoscopic cholecystectomy +% (7) 1. Wound infection 4 (1.87) 4 (1.87) 0 2. Common bile duct injury 1 (0.47) 0 1 (0.47) 3. Bile leakage post operation 1 (0.47) 0 1 (0.47) 4. Gallbladder leakage 4 (1.87) 0 4 (1.87) 5. Pulmonary complication 2 (0.93) 2 (0.93) 0
6. Bleeding 3 (1.40) 0 3 (1.40)
7. Death 1 (0.47) 1 (0.47) 0
% 16 (7.48 ) 7(3.27) 9 (4.21)
U%7\-',",*O%F- -* , 16 (7 7.48) %F-G,@ 7 (7 3.27) 7%F-O 9 (7 4.21) %&7 .,,-*
1. Wound infection +% 4 (7 1.87) ,(",,%%F-G,@* , "#$%-.!
% 38 \\-O ", 3 o 4 % h7"O.- 3 .!,( @-%7 +"
"- 1 ( @-%7 ,. * , +"% %",-!*+ resuture ( -&* "#$%
.,
2. Common bile duct (CBD) injury +% 1 (7 0.47) ("#$% 65 8 - adhesion !h7
", identified cystic duct 7,( gallbladder ,.%- CBD injury O"#$%
",%-' 3 - 4 %-% T!* %T, billirubin 7 alkaline phosphatate !* &,%7-
O CBD injury ",G,@
complete tear CBD ,* 2 ,)# clip .% ., .!,+", Roux o en o Y hepatico o jejunostomy ( @-%7 "#$%,-!*
3. Bile leakage post operation +% 1 (7 0.47) ", 2 % "#$%-%, T, (bile peritonitis) % generalize tenderness guarding .!,+",G,
@%-*+,-'% bile duct %h gallbladder bed .,]\7(O sump drain (
@-%7 "#$%,-!* .- bile off drain 4. Gallbladder leakage +% 4 (7 1.87) !h7",-)*+,-'%7'% , .!,+'%( ,%+
(O7.% ",( @-%7 ,#
.- bile ),7
5. Pulmonary complication +% 2 (7 0.93) % Pneumonia ", 2 o 3 %
"#$%-.! '- ( T'] i,., O- crepitation \ ,%- infiltration both lung "#$%.,
6. Bleeding +% 3 (7 1.40)
%,- injury cystic artery 7- adhesion .!, clear %h cystic artery
% clip &%&, proximal cystic artery O) ,T,.,
7. Death +% 1 (7 0.47) T'
"#$% 7-7% steroid abused !h7
",- unstable vital sign ",-U%7 Acute Myocardial Infraction \ &T' %(
-' %T, Tropronin - T .,"% ., %( "#$%.,-
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+-'O#%795 1,3,6
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O%( D.,.7 5 17 (,
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,U%7\ 7 (7 3.27) 7%F- O 9 (7 4.21) \' ,U%7\",,%%F-G,
@.,7 4 - 6 7,%%F-O .,7 2 o 6 17 77%-'(@(",,%%F- G,@%F-O(&-,S-' 85.65 -(1.43 @.), 88.42 - (1.47 @..) +, 7%* 2 %F-&(@77%S-'(
", 7("#$%-'-iD 7 %
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%- CBD stone, intrahepatic duct stone -'"
G, CBD T' remove stone ,S7T'+
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", LC -'-U%7 adhesion , '%% T + IOC ' 7(@% ).-iD (,j!h7
", LC (@%'+O, 40 - "+%%
",,%%F-G,@%
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,#(@,* ,+( "#$% early ambulation .,
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",,,", Ambulatory laparoscopic cholecystectomy "#$% 7T"#$%
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2. 7F O 7&h7. O
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3. F.Charles Brunicardi,et al. Gallbladder and extrahepatic billiary system. In : Schwartz ms Principles of surgery.8 th ed. USA : Mc-Graw Hill, 2005.
4. Latha G. Stead,et al. First Aid For The Surgery clerkship. 2 nded. USA : Mc-Graw Hill, 2003.
5. @@@ ,. ""#$%)
*+,-OS-(,+O7,%.
%O ! 6o7 2548 ; 8-' 24 S-' 3 : 223-234 .
6. %- @# 7&h7. Endoscopy Diagnosis and Intervention in HBP Disease.
O %%r 24. &*-' 1. x : O+ %@O, 2546.
7. . @ . +O
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x : O@@' +,, 2538.
8. R.C.G Russell, Norman S Williams and Christopher JK Bulstrode. Short Practice of Surgery 24th ed. British : Phoenic Photosetting, 2004.
9. Soper NJ. Laparoscopic treatment of gallstone.In: Advances in minimally invasive Surgery.
Vol.1;Master series in surgery:33 o 72.
10. %r@ FF. ",@
,%F-O. &*-' 1. x : T%
, 2540.
11. U#D@# 7&h7. ",)
*+,-,O@(#
,F- : "",(77. %O &T! 6/2 2540 ; 8-' 4 S-' 3 : 18-27.
12. R Aggarwal, K Moorthy and A Darzi.
Laparoscopic skills training and assessment. British Journal of Surgery 2004 :1549-58.
13. 7Ow !. ",)*+,-"
%, ( : "", (77.%O &T! 6/2 2538 ; 8-' 3 S-' 1: 57 o 62.
14. Poon CM, et al. Two oport versus four o port laparoscopic cholecystectomy. Surgical Endoscopy 2003 ; 17(10) : 1624-7.
15. Garth H Ballantyne. Atlas of Laparoscopic Surgery.1 st ed. USA : W.B. Saunder Company, 2000.
16. Wang WK. Successful Laparoscopic Management of Cholecysto enteric fistula. Journal of Gastroenterology 2006 ;12(5) : 772-5.
17. O& @.",)*+,-,%
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. ! 1 2545 ; 8-' 4 S-' 2 : 57-60.
