腹腔镜胆囊切除术严重并发症10例分析

目的对腹腔镜胆囊切除术发生严重并发症的常见原因进行分析. 方法回顾分析986例腹腔镜胆囊切除术中出现的10例严重并发症的诊治经过. 结果因钛夹松脱致胆漏2例,膈下脓肿1例,胆总管损伤3例,胆总管残余结石2例,十二指肠损伤1例,气腹针穿刺致空肠穿孔1例.经治疗未出现严重后果. 结论导致腹腔镜胆囊切除并发症的原因为局部粘连、炎性水肿严重,脐孔周围严重的腹腔粘连,胆囊解剖的变异,术者经验欠丰富、操作欠熟练.     

Laparoscopic cholecystectomy in a patient with a biventricular cardiac assist device.

Evaluation and management of abdominal pathology in patients with ventricular assist devices is likely to become increasingly important as the utilization of these devices expands. Ventricular assist devices represent a class of intracorporeal or paracorporeal mechanical devices that augment cardiac output in patients with congestive heart failure. Patients with ventricular assist devices supporting both right and left ventricles (biventricular assist devices) are uniquely challenging to the general surgeon because these devices restrict direct access to the abdominal cavity and because of the perioperative implications of biventricular heart failure. We describe herein the first reported successful laparoscopic cholecystectomy in a patient with a paracorporeal biventricular assist device. Cholecystectomy was performed in this patient for acute cholecystitis that occurred while the patient was awaiting heart transplantation. Our results add weight to the small body of evidence that laparoscopy is well tolerated in ventricular assist devices patients. The unique aspects of the biventricular assist device patient make laparoscopic abdominal intervention particularly suitable in this patient population.     

LC手术治疗胆囊结石嵌顿226例临床分析

目的探讨LC治疗胆囊结石嵌顿的经验。方法回顾性分析我院2004年1月-2008年10月用LC治疗胆囊结石嵌顿226例的临床资料。结果215例成功施行LC,11例中转开腹,1例术后发生胆瘘,2例胆管损伤,无死亡病例,全部患者均痊愈出院。结论由于病例数的累积,术者腔镜技术的不断提高,对于胆囊结石嵌顿,采取适当的个体化方案,LC可作为首选,术后恢复快、痛苦小、并发症少。     

老年人腹腔镜胆囊切除术172例报告

目的 :探讨老年人腹腔镜胆囊切除术的安全性、可行性及注意点。方法 :对 172例老年人胆囊良性病变进行腹腔镜胆囊切除术。其中伴有并存病 96例 (5 5 .81% )。结果 :172例病人均恢复良好 ,无并发症发生 ,无中转开腹病例。结论 :只要做好围手术处理 ,老年人行腹腔镜胆囊切除术是安全可行的。     

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study

BackgroundPolypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications.MethodsA large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG.ResultsPatients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion.ConclusionsConsidering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.     

A case report of double cystic duct during laparoscopic cholecystectomy in patient with chronic calcular cholecystitis

IntroductionAbnormal anatomy of the biliary tree predisposes patients to higher risks of ductal injury and postoperative complications. One of the extremely rare abnormalities of the cystic duct is the duplication of the cystic duct with a single gallbladder. The diagnosis is usually established during surgery. we report a case of double cystic duct with literature review.Presentation of caseA forty-two years old female patient who complained of recurrent biliary colic 9 months prior to the presentation. Murphy’s sigh was negative and with no other relevant clinical signs.Diagnosis and therapeutic interventionAbdominal ultrasound showed multiple gall stones; the largest one was about 11 mm in diameter. Laparoscopic cholecystectomy was done under general anesthesia with 4 ports insertion. A double cystic duct accidentally encountered after clipping and cutting what was apparently a single cystic duct. Intraoperative cholangiogram was done to confirm the anomaly and exclude CBD injury.ConclusionDouble cystic duct is a very rare variant of the cystic duct anomaly. Proper knowledge of this anomaly should be kept in mind to avoid any unnecessary steps.     

异丙酚乳剂用于腹腔镜胆囊切除术40例体会

目的：探讨异丙酚乳剂用于腹腔镜胆囊切除术麻醉中的优缺点。方法：１００例施行腹腔镜胆囊切除术患者,随机分为异丙酚组４０例,硫喷妥钠组６０例。观察记录两组患者手术前、给药后１ｍｉｎ、气管插管时、插管后５ｍｉｎ、ＣＯ２气腹后３ｍｉｎ血流动力学各参数并观察停药后患者苏醒情况及麻醉副作用等。结果：异丙酚比硫喷妥钠更适用于腹腔镜胆囊切除术麻醉,但也要注意异丙酚对呼吸、循环系统功能的抑制作用。     

胆囊切除术中损伤胆管的原因分析和防治体会

目的：研究在胆囊切除术中,损伤肝外胆管的的原因和预防方法;方法：对２０年来胆囊切除术发生肝外胆管损伤的病例行回顾性系统分析;结果：１０５０例胆囊切除术３１例胆管损伤的病例,损伤发生率为２．９５％。３１例中９例为胆管完全横断;损伤超过周径５０％的２例,不足５０％的７例,因钳夹过度撕死伤９例;链扎伤４例。术中发现损伤２２例,当即行胆道重建术,其中端端吻合７例,胆管总十二指肠吻合２例,修补１２例,拆除缝     

术中胆道造影在腹腔镜胆囊切除术中的应用价值

目的 评价术中胆道造影技术在腹腔镜胆囊切除术中的应用价值。方法 腹腔镜胆囊荨除术中经胆囊管插管行胆道造影共１４６６例,１３８２例造影成功,成功率为９４．２７％。结果 术中造影发现胆总管结石９２例,胆管损伤８例,副肝管１例。结论术中造影操作迅速,安全,显影清晰成功率高,能降低胆管损伤发生率;提高腹腔胆囊切除术的质量,值得推广应用。