老年急性胆囊炎患者行腹腔镜胆囊切除术的治疗体会(附50例报告)

目的:探讨为老年急性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床效果。方法:回顾分析2006年10月至2008年10月为50例老年急性胆囊炎患者行LC的临床资料。结果:47例成功施行LC,手术时间35～155min,平均65min,术后1～3d恢复进食,术后住院3～10d,平均6d;腹腔镜下行胆囊造瘘术1例;中转开腹2例,手术成功率94%。1例术后并发肺内感染,经对症治疗后痊愈。无死亡病例及胆漏、出血等术后并发症发生。结论:只要病例选择得当,LC可作为治疗老年急性胆囊炎的理想术式。     

经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗老年急性梗阻性胆囊炎的体会

目的:探讨B超引导下经皮经肝胆囊穿刺引流(percutaneous transhepatic gallbladder drainage,PTGD)联合二期腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗老年急性梗阻性胆囊炎的疗效。方法:回顾分析2008年1月至2011年2月为78例老年急性结石性胆囊炎患者行PTGD联合二期LC的临床资料。结果:78例均穿刺置管成功,术后2～3 h腹痛减轻,体温24～48 h降至正常,PTGD管平均留置13.5天,分别于6～48天后行LC。3例中转开腹,无一例因急性梗阻性胆囊炎及相关治疗导致的严重并发症或死亡。结论:PTGD联合二期LC是治疗老年急性梗阻性胆囊炎安全、简便、有效的方法。老年急性梗阻性胆囊炎应尽量避免急诊常规手术,宜先行PTGD,缓解炎症,以免发生胆囊穿孔,待二期择期行LC。     

腹腔镜胆囊切除术治疗急性胆囊炎的疗效分析(附103例报告)

目的:探讨急性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及临床价值。方法:回顾分析2006年1月至2008年6月我院为103例急性胆囊炎患者行LC的临床资料。结果:100例成功完成LC;3例中转开腹(2.91%),均为发病72h后行LC,其中1例Calot三角区严重水肿、粘连致密,无法辨清胆管关系,Mirizzi综合征及胆囊十二指肠瘘各1例。手术时间30～140min,平均80min。均痊愈出院,随访6～60个月,平均28.5个月,无并发症发生及死亡病例。结论:急性胆囊炎行LC,难度大,但只要合理选择患者,把握手术时机并注重手术技巧,急性胆囊炎患者行LC是安全可靠的。     

腹腔镜胆囊切除术治疗急性胆囊炎的临床体会(附76例报告)

目的:探查急性胆囊炎行腹腔镜胆囊切除术(laparsocopic cholecystectomy,LC)的可行性及安全性。方法:回顾分析为76例急性胆囊炎患者行LC的临床资料。结果:68例成功完成手术,8例(10.4%)中转开腹,无并发症发生。手术时间35～120min,平均80min;住院5～15d,平均7.6d;术后效果良好。结论:完善的术前检查、娴熟的腹腔镜技术、耐心细致并严格把握中转开腹指征,为急性胆囊炎患者行LC是安全、可靠的。     

损伤控制理念在老年中重度急性胆囊炎治疗中的应用

目的探讨损伤控制理念在老年中重度急性胆囊炎治疗中的应用。方法回顾性收集2014年1月至2016年1月上海市浦东医院收治的148例老年中重度急性胆囊炎患者的临床资料;比较患者行经皮经肝胆囊穿刺引流术(PTGBD)后择期行LC(择期LC组,n=52例)和急诊行LC(急诊LC组,n=96例)的有效性及安全性。结果 PTGBD后择期LC组患者术中出血量较少(P0.05);两组中转开腹率差异虽无统计学意义(P0.05),但PTGBD后择期LC组中转开腹率较低(5.77%vs 12.50%);PTGBD后择期LC组并发症总发生率为40.38%,显著低于急诊LC组的59.38%(P0.05)。结论结合损伤控制理念,对老年中重度急性胆囊炎患者PTGBD后行择期LC手术能有效降低手术风险,是治疗老年中重度急性胆囊炎的优选方案。     

急性胆囊炎行腹腔镜胆囊切除术的体会(附275例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎的手术时机和手术技巧。方法:回顾分析2004年8月至2009年12月为275例急性胆囊炎患者施行LC的临床资料,总结成功为急性胆囊炎患者行LC的经验。结果:本组242例成功完成LC,33例中转开腹,全组无死亡病例及大出血等严重并发症发生,仅1例胆管损伤。结论:急性胆囊炎在发病早期(72h内)应用适当的手术技巧,多数急性胆囊炎患者行LC是安全可靠的。     

急性胆囊炎腹腔镜手术时机选择与费用关系

目的:探讨急性胆囊炎腹腔镜手术的时机选择,分析其与住院费用的关系。方法:回顾分析2004年1月至2010年12月为427例急性结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料。按胆囊炎发作至手术的时间分为早期手术组(ELC)、延期手术组(DLC)和择期手术组(SLC)。结果:3组患者并发症发生率差异无统计学意义(P>0.05)。ELC组手术时间平均(63.65±15.63)min,术中出血量平均(64.26±32.04)ml,平均住院(4.74±2.22)d,住院费用平均(10 504±1 982)元,中转开腹率2.7%。DLC组手术时间平均(94.24±29.51)min,术中出血量平均(174.95±64.39)ml,平均住院(8.00±3.83)d,住院费用平均(15 230±2 267)元,中转开腹率8.3%。SLC组手术时间平均(65.35±14.49)min,术中出血量平均(65.44±38.91)ml,平均住院(13.91±4.38)d,住院费用平均(19 032±4 495)元,中转开腹率2.2%。DLC组手术时间、术中出血量及中转开腹率明显高于ELC组、SLC组(P<0.05)。3组住院时间、住院医疗费用按病程时间依次增加(P<0.05)。结论:急性胆囊炎早期手术安全有效,并可减少住院时间,降低医疗费用,在治疗结果和生活质量上均具有优势。     

急性结石性胆囊炎的腹腔镜治疗体会

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性结石性胆囊炎的经验.方法:回顾分析为457例急性结石性胆囊炎患者行LC的临床资料.结果:432例手术成功,25例中转开腹,患者均痊愈出院.结论:为急性结石性胆囊炎患者施行LC安全可行,成功的关键在于手术技巧和中转开腹指征...     

762例老年患者行腹腔镜胆囊切除术的临床分析

目的:探讨老年患者胆囊结石特点,总结为老年患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床经验。方法:回顾分析1998年1月至2008年8月我院为762例60岁以上老年患者行LC的临床资料。结果:749例LC成功,其中行胆囊大部切除术5例,中转开腹13例,术中胆管损伤3例,胆漏3例,死亡1例,无其他严重并发症发生。结论:老年患者中急性胆囊炎和萎缩性胆囊炎所占比例较高,手术风险大。把握手术时机,积极处理合并症,为老年患者行LC是安全可行的。     

急性结石性胆囊炎早期腹腔镜手术的可行性及手术方法探讨

目的:探讨急性结石性胆囊炎患者症状发作72h内行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及合理的手术方法。方法:回顾分析136例急性结石性胆囊炎患者的临床资料,并与同期行LC治疗1 165例非急性发作期胆囊结石患者在手术时间、并发症发生率及中转开腹率等方面比较。结果:136例早期行LC的急性结石性胆囊炎患者平均手术时间、并发症发生率及中转开腹率与同期行LC治疗的1 165例非急性发作期胆囊结石患者差异无统计学意义(P>0.05)。结论:急性结石性胆囊炎在症状发作72h内行LC是安全可行的。手术成功的关键是Calot三角的正确处理,减少并合理处理术中出血是降低肝外胆管损伤和中转开腹率的重点。     

Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis

Aim: The present study was conducted to evaluate the effectiveness of early scheduled laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis. Patients and methods: 31 patients with acute cholecystitis were treated by early scheduled LC following PTGBD (group 1). These patients were compared with 9 patients treated by early LC without PTGBD (group 2) and with 12 patients treated by delayed LC following conservative therapy (group 3) for the success rate of intraoperative cholangiography, the conversion rate to open cholecystectomy, operative time, and hospital stay. Early scheduled LC following PTGBD was defined as scheduled LC when the patient's condition recovered and it was performed 1–7 days (mean: 4 days) after admission. The patients' age in group 1, 2, and 3 was 66 ± 13, 65 ± 10, and 64 ± 9 years, respectively, without significant difference. Most of the patients had additional diseases. Results: The success rate of intraoperative cholangiography was 97% (30/31) in group 1, 67% (6/9) in group 2, and 67% (8/12) in group 3. The conversion rate to open cholecystectomy was 3% (1/31) in group 1, 33% (3/9) in group 2, and 33% (4/12) in group 3. The operative time for LC was 89 ± 33 min in group 1, 116 ± 24 min in group 2, and 135 ± 30 min in group 3. The mean hospital stay after LC was 9 ± 4 days in group 1, 9 ± 3 days in group 2, and 17 ± 7 days in group 3. In group 1, the success rate of intraoperative cholangiography was higher, the conversion rate to open cholecystectomy was lower, and operative time was shorter than in groups 2 and 3 with significant difference (p <0.05, p <0.05, and p <0.01, respectively). Conclusion: The findings of this study indicate that early scheduled LC following PTGBD is a safe and effective therapeutic option for patients with acute cholecystitis especially in elderly and complicated patients.     

Is there an optimal time for laparoscopic cholecystectomy in acute cholecystitis?

Background Laparoscopic cholecystectomy (LC) is safe in acute cholecystitis, but the exact timing remains ill-defined. This study evaluated the effect of timing of LC in patients with acute cholecystitis. Methods Prospective data from the hospital registry were reviewed. All patients admitted with acute cholecystitis from June 1994 to January 2004 were included in the cohort. Results Laparoscopic cholecystectomy was attempted in 1,967 patients during the study period; 80% were women, mean patient age was 44 years (range, 20–73 years). Of the 1,967 LC procedures, 1,675 were successful, and 292 were converted to an open procedure (14%). Mean operating time for LC was 1 h 44 min (SD ± 50 min), versus 3 h 5 min (SD ± 79 min) when converted to an open procedure. Average postoperative length of stay was 1.89 days (± 2.47 days) for the laparoscopic group and 4.3 days (± 2.2 days) for the conversion group. No clinically relevant differences regarding conversion rates, operative times, or postoperative length of stay were found between patients who were operated on within 48 h compared to those patients who were operated on post-admission days 3–7. Conclusions The timing of laparoscopic cholecystectomy in patients with acute cholecystitis has no clinically relevant effect on conversion rates, operative times, or length of stay.     

腹腔镜胆囊切除术治疗急性结石性胆囊炎56例临床分析

目的:探讨急性结石性胆囊炎患者行腹腔镜胆囊切除术的可行性、安全性。方法:回顾分析我院为56例急性结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料。结果:52例成功完成腹腔镜手术,成功率92.9%,4例中转开腹,中转率7.1%,无严重并发症发生,患者均痊愈出院,疗效满意。结论:急性结石性胆囊炎在急性炎症期行腹腔镜胆囊切除术安全可行。     

老年急性胆囊炎患者腹腔镜胆囊切除术的手术难点及对策

目的:探讨老年复杂型急性胆囊炎患者施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术难点及对策.方法:回顾分析2004年8月至2010年10月收治的103例老年急性胆囊炎患者的临床资料.结果:97例(94.2%)成功完成LC,4例(3.9%)中转开腹,2例术后合并胆总管结石,行...     

Variation in the use of laparoscopic cholecystectomy for acute cholecystitis: a population-based study

HYPOTHESIS: There is wide variation in the use of laparoscopic cholecystectomy (LC) for acute cholecystitis among all public hospitals in Hong Kong. The objective of this study was to determine the factors responsible for the use of LC for acute cholecystitis in a stable population. DESIGN: A retrospective survey on 2353 patients with pathologically proven acute cholecystitis treated with cholecystectomy in Hong Kong from 1998 to 2002. SETTING: All public hospitals in Hong Kong. RESULTS: The rate of using LC for acute cholecystitis increased by 30.4% from 1998 to 2002. We observed a wide variation in the use of LC for acute cholecystitis ranging from 3.7% to 92.9% (P<.001). There was no correlation between the number of cholecystectomies performed and the percentage of LCs performed in each hospital (P = .39). Logistic regression analysis showed that the hospital, year of operation, and age of the patients were independent variables for LC. CONCLUSIONS: A wide variation in the use of LC for acute cholecystitis was observed among the public hospitals in Hong Kong. Young female patients from selected hospitals recently are more likely to be treated with LC.     

腹腔镜手术治疗急性胆囊炎190例临床体会

目的:总结腹腔镜下处理急性胆囊炎的临床经验.方法:回顾分析2005年3月至2010年12月为190例急性胆囊炎患者施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料.结果:176例成功完成LC,14例中转开腹,无死亡病例及大出血等严重并发症发生.结论:LC治疗急性结石性胆囊...     

Role of fundus-first laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients

BACKGROUND: Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the loss of the advantages of this minimally invasive procedure and significantly increases length of hospital stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent among patients with acute cholecystitis and in elderly patients. This study evaluated whether fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with acute cholecystitis. MATERIALS AND METHODS: During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care university hospital in central Taiwan. RESULTS: The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications--port-site infection and subhepatic fluid collection-occurred in two patients (5.5%). CONCLUSION: Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon.     

Laparoscopic cholecystectomy: a safe approach for management of acute cholecystitis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy (LC) is increasingly being used as an appropriate early treatment in patients with cholecystitis. This study evaluated the safety, effectiveness, and complications of LC in all cases of acute cholecystitis. METHODS: A retrospective study involved the patients who underwent LC for acute cholecystitis within 72 hours of admission. The preoperative diagnosis was based on clinical, laboratory, and echographic examinations, while the final diagnosis was confirmed by histopathological examination of the excised gallbladder. RESULTS: We identified 184 patients with acute cholecystitis. Intraoperative cholangiography (IOC) was not performed. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 62 patients (33.7%), and postoperative ERCP in 13 patients (7.1%). Conversion to open cholecystectomy was necessary in 19 patients (10.3%); 16 patients for severe inflammation and adhesions and 3 patients because of uncontrolled bleeding. The mean operative time was 68 minutes. No deaths occurred. The overall complication rate was 6% with 3 postoperative bile leakages and 2 nonbilious subhepatic collections. The mean postoperative hospital stay was 2.8 days. CONCLUSIONS: LC is a safe, effective procedure for the early management of patients with acute cholecystitis. LC can be safely performed without routine IOC when ERCP is performed preoperatively on the basis of specific indications. Meticulous dissection and good exposure of Calot's triangle may prevent bile duct injuries.