Laparoscopic colorectal surgery – results from 200 patients

OBJECTIVE: Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short-term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years. METHOD: A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest. RESULTS: Two hundred and thirty-one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter-quartile range (IQR) 57-76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90-150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15-30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re-operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3-6) and 13 patients (6.5%) were re-admitted within 30 days of hospital discharge. CONCLUSION: Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.     

腹腔镜治疗老年萎缩性胆囊炎44例临床分析

目的:探讨老年萎缩性胆囊炎患者的腹腔镜治疗方法,并预防胆管损伤并发症的发生。方法:回顾分析腹腔镜治疗老年萎缩性胆囊炎44例患者的临床资料。结果:41例顺利完成手术,3例中转开腹,12例放置腹腔引流管,术后肝下积液1例,无其他并发症发生及死亡病例。结论:老年人萎缩性胆囊炎的腹腔镜治疗属于复杂手术,与术中操作技巧,把握好中转手术的时机,充分围手术期准备,熟练术中操作技巧,把握中转开腹的时机,合理使用器械等是预防和减少并发症的关键。     

腹腔镜胆囊切除术中胆道造影的临床意义

目的:探讨术中胆道造影对行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)患者的临床意义。方法:回顾性分析113例因胆囊结石行LC加术中胆道造影患者的情况。结果:113例患者中造影成功110例(成功率97%),发现胆总管结石5例,占4.5%(5/110)。结论:LC加术中胆道造影有利于防止胆道残余结石,对正确判断胆道解剖关系,减少胆道损伤有重要的临床意义。LC加术中胆道造影可常规使用。     

腹腔镜治疗急性结石性胆囊炎的体会

目的 探讨腹腔镜治疗急性结石性胆囊炎的手术指征、手术时机和手术技巧.方法 对265例急性结石性胆囊炎施行腹腔镜胆囊切除术.结果 239例成功,26例中转.结论 腹腔镜治疗急性结石性胆囊炎是安全可靠的手术方式.     

经蓝碟(LapDisc)手助腹腔镜结直肠癌根治术

目的 探讨手助腹腔镜结直肠癌根治术的临床效果。方法 应用LapDisc手助腹腔镜技术完成27例结直肠癌根治术。结果 手术全部成功，无一例中转开腹。手术时间90～260min，平均140min。术中出血50～200ml，平均110ml。术后无死亡及吻合口漏等并发症。随访6～23个月，平均8．6月，未见切口种植复发。结论 手助腹腔镜结直肠癌根治具有安全、创伤小、术后恢复快及降低标准腹腔镜手术难度等优点，值得临床推广应用。     

胆囊结石合并胆管结石微创治疗方案的选择

目的探讨胆囊结石合并继发胆道结石微创治疗的合理方案。方法108例胆囊结石合并可疑胆道继发结石均行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC），其中腹腔镜联合胆道镜经胆囊管胆道探查取石（laparoscopic transcyctic common bile duct exploration，LTCBDE）＋LC70例，腹腔镜联合胆道镜胆总管切开胆道取石（laparoscopic common bile duct exploration，LCBDE）＋LC35例，其中放T管14例，不放T管21例，内镜乳头肌切开术（endoscopic sphincterotomy，EST）术后行胆囊切除3例。结果LCBDE＋LC术后放T管组中有1例胆漏经保守治疗治愈，4例术后胆道造影发现胆道残余结石经胆道镜取出结石治愈．其他病例无胆漏，术后3月复查B超无残余胆道结石，所有病例术后无胰腺炎发作。结论在胆囊结石继发胆道结石的治疗中合理选择多种微创手术方法能降低创伤及减少并发症的发生。     

腹腔镜胆囊切除术中腹腔引流管的应用体会

目的：总结腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中腹腔引流管的临床应用经验。方法：回顾分析2001年1月至2006年6月1650例LC患者的临床资料。结果：1650例中1487例（90.1%）术中未放置腹腔引流管,恢复顺利,放置腹腔引流管的163例中159例（97.5%）引流管无明显液体引出,或仅有少量腹腔冲洗液,术后24～48h拔除,康复好,4例患者术后发生胆漏。结论：应严格掌握放置腹腔引流管的指征,多数LC术中不放置腹腔引流管是合理可行的,更有利于患者的康复。     

气压弹道碎石联合胆道镜技术配合手术治疗肝胆管多发结石

目的探讨应用经输尿管镜气压弹道碎石技术联合经胆道镜等离子碎石技术配合传统技术治疗弥漫性、多发性肝胆管结石的手术方法,以期提高净石率和手术疗效。方法回顾性分析我院2002年9月～2005年1月采用经输尿管镜气压弹道碎石技术联合经胆道镜等离子碎石技术配合传统技术治疗肝胆管结石35例的临床资料。结果本组净石率为91.42%。获得随访的25例近期生活质量良好,远期疗效尚待观察。结论双镜配合手术治疗复杂肝内胆管结石充分发挥了各自的优势,手术效果较好。     

基层医院腹腔镜胆囊切除术1 696例的治疗体会

目的:探讨腹腔镜在基层医院普及开展的可行性和主要并发症的预防.方法:回顾分析1999年6月至2006年5月我院1 696例腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料.结果:1 696例LC成功 1 635例,中转开腹61例,中转率3.6%,发生并发症17例,其中胆管损伤1例,腹腔内出血2例,胆漏2例,腹腔感染1例,胆管残石3例,遗漏腹腔内病变6例,上消化道出血2例.结论:LC在基层医院的开展日益成熟,成为治疗胆囊良性疾患的"金标准".术前注意鉴别诊断,术中操作轻柔,辨明胆囊三角结构,能避免严重并发症的发生.     

腹腔镜和胆道镜治疗胆囊胆总管结石的体会

目的探讨腹腔镜和胆道镜治疗胆囊胆总管结石的临床效果。方法2003年7月-2005年8月我院有18例胆囊并胆总管结石手术先行腹腔镜胆囊切除，然后切开胆总管用胆道镜探查，取出胆总管结石。结果1例腹腔镜胆囊切除术中转开腹，17例均顺利完成腹腔镜胆囊切除、胆道镜胆总管探查术。结论腹腔镜和胆道镜治疗胆囊胆总管结石的临床效果可靠。