有上腹部手术史患者的腹腔镜胆囊切除术

目的 探讨对既往有上腹部手术史的患者进行腹腔镜胆囊切除术(LC)的可行性,并从多方面评价其效果.方法 对我院2000年1月至2007年10月实施的2520例LC病例选择入组1776例,分为无手术史组1691例,有手术史组85例,比较2组年龄、性别、手术时间、中转例数、粘连例数、需要分离粘连例数、术后住院时间和并发症等方面的差别.结果 无手术史组45例有粘连,26例需要分离,手术时间为(45.2±21.0)min,中转手术31例,术后住院时间(4.6±1.5)d,并发症23例;有手术史组粘连例数为66例,51例需要分离,手术时间(60.5±26.3)min,中转手术7例,术后住院时间(5.5±1.3)d,并发症2例.2组患者术后住院时间和术后并发症的发生例数差异无统计学意义(P均>0.05);在手术时间、中转例数、粘连例数、需要分离的粘连例数差异有统计学意义(P均<0.05).结论 对既往有上腹部手术史的患者进行LC术是安全可行的.

Laparoscopic cholecystectomy in patients with previous upper abdominal operations

Objective To evaluate the feasibility of laparoscopic cholecystectomy(LC) in patients with previous upper abdominal operations.Methods Among 2520 patients admitted in our hospital from January,2000 to October,2007 underwent LC,excluding those with acute cholecystitis,gall-stone,cystic polypus,acute biliary pancreatitis,severe obesity or hepatic calculus,there were 1691 patients without history of upper abdominal operation,and 85 patients with history of upper abdominal operation.Age,sex,operation times,postoperative complications such as adhesion and separation of adhesion required and hospital stay were reviewed and analyzed.Results In the group without previous operation,45 patients occurred adhesion and separation was required in 26 patients.The operation time was (45.2±21.0) minutes,and the hospital stay was (4.6±1.5) days.Complications occurred in 23 patients.In the group with previous upper abdominal operation,66 patients occurted adhesion and separation was required in 51 patients.The operation time was (60.5±26.3) minutes,and the hospital stay wag (5.5±1.3)days.The postoperative complications and hospital stay between two groups show no difference (P>0.05).However,the differrence of operation time,cages of convertion to operation adhesion and separation required were significant(P<0.05).Conclusions Laparoscopic cholecystectomy Can be applied safely in patients with previous upper abdominal operations.