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41 Document code: B Article ID :1009 -5551 (2004) 01-0079-01 open cholecystectomy (0C) has been 100 years of history, has become a more secure and standard surgery. But because of chronic cholecystitis with cystic atrophic chronic inflammatory hyperplasia, hypertrophy, fibrosis and cystic triangle (Calot triangle) and severe scar characteristics, if the conventional cholecystectomy prone to gallbladder bed bleeding, residual gallbladder, bile duct injury and other complications . Our hospital in December 1997 ~ December 2002 asked the 72 patients with chronic atrophic cholecystitis with subtotal cholecystectomy and scraping, burning, residual coagulation method for treatment of gallbladder mucosa, results were satisfactory, are reported below. l Materials and Methods 1.1 General Information The group 72 patients, 27 males and 45 females, aged 26 to 72 years, mean 51 years old. Course of 3 to 12 years with an average of 5.5 years. 72 patients had gallbladder stones. 56 cases of emergency surgery, elective surgery in 16 patients. Abdominal B-show: the gallbladder was significantly reduced, uniform wall thickening, intracystic stones are mostly full of type, common bile duct or in the normal mild compensatory enlargement. 1.2 Methods laparotomy fully reveal the surgical field, conventional abdominal exploration, see the gallbladder on average 4cm × 25cm size, thickness, hard, fibrosis, Calot triangle anatomy is unclear, not thick or slightly thickened common bile duct, the hand Probe no stones. First,[link widoczny dla zalogowanych], cut the bottom of the gallbladder, bile net absorption (mostly white bile), take the net stones, close to the liver margin (aimed at reducing the residual gallbladder wall), electric knife removal of the gallbladder and the body bottom, close to the common bile duct or part of the wall of hepatic duct is not removed, so as not to damage the common bile duct or hepatic duct. Bring the gallbladder neck, under the guidance of the probe to identify the cystic duct, close to the sharp separation of the cystic duct, you can successfully isolate the cystic duct thinning, in identifying three (hepatic duct, cystic duct, common bile duct) convergence structure After the beginning part of 0.5cm in the cystic duct cystic duct at the suture, electric condensate, phenol painting, scraping spoon scraping and other methods to dispose of residual mucosa, avoid excessive force,[link widoczny dla zalogowanych], too deep,[link widoczny dla zalogowanych], and not to harm the liver caused by seepage blood. Repeatedly washing the wound with saline, as the case is set to decide whether drainage tube. 2 Results 72 patients were uneventful recovery after surgery, wound healing in 64 cases, 8 cases of liquefaction of fat, no abdominal infection. After review of B-57, no diaphragm and gallbladder fossa fluid. Histological examination showed mucosal thickening, congestion and lymphocyte infiltration and fibrosis. 3 Discussion atrophic chronic cholecystitis is gallbladder wall inflammatory cell infiltration in the gallbladder until the destruction of the organizational structure, fiber scarring, atrophy of a chronic gallbladder disease. At present, most scholars [1] advocated chronic atrophic cholecystitis gallbladder as a special type of subtotal cholecystectomy can do to retain part of the gallbladder wall in the liver and gallbladder mucosa by scraping residue, coagulation, destruction of phenol painting, etc., so that surgical treatment can achieve the purpose of avoiding damage the liver and biliary tract, the treatment group and reported in literature. Dan Jingsen so 0 that the gallbladder is caused by remnants of subtotal resection of the most common cause of gallbladder. Our experience is that the surrounding tissue in the gallbladder neck and severe adhesions, Calot triangle dissection difficulties, subtotal cholecystectomy should do first, and then under the guidance of the probe to identify the cystic duct, cystic duct in the ampulla side close to the sharp separation (not electric coagulation to prevent bile duct injury), so can avoid the occurrence of residual gallbladder and avoid residual cystic duct is too long. Anton equal Ⅲ that the posterior wall of the gallbladder residual gallbladder remnant gallbladder easily lead to residual cancer. 72 patients in this group, 57 cases were reviewed in the previous abdominal B-and short-term follow-up, when asked less than 1 year has not been the cancer, which may be asked follow-up after a short number of cases less relevant. We believe that the key to successful operation of preoperative CT, B-ultrasound diagnosis, and residual gallbladder surgery is not completely destroyed mucosa and residual cystic duct with the guide wire to identify,[link widoczny dla zalogowanych], after routine specimens sent for pathological examination to exclude early cancer.

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