腹腔镜胆囊切除术结石漏入腹腔的预防

目的:探讨腹腔镜胆囊切除术（LC）中结石漏入腹腔的原因、预防措施及处理方法。方法:回顾分析1510例LC术中73例结石漏入腹腔发生的原因及处理方法。结果:结石自胆囊管破口漏出6例,牵拉和剥离致胆囊破裂结石漏出41例,自腹壁戳孔取出胆囊时拉破19例,血管钳扩大戳孔刺破胆囊7例。漏入腹腔的结石均被取出,2例中转为开腹取石。此组结石漏入腹腔的发生率为4.8％（73/1510）。结论:LC术中剥离和取出胆囊过程是结石漏入腹腔的主要发生时期,防止胆囊分破和取出时拉破是预防结石漏入腹腔的关键。     

腹腔镜胆囊切除术结石漏入腹腔的原因及对策

目的：探讨腹腔镜胆囊切除术结石漏入腹腔的原因及防治对策。方法：回顾性分析我院1998年至2007年1200例腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）结石漏入腹腔的临床资料。结果：1200例LC共发生结石漏入腹腔61例,随访1-8年,无腹腔脓肿、窦道形成等并发症发生。结论：LC术中胆囊分破、取出时撕破、血管钳扩开戳孔时刺破胆囊是结石漏入腹腔的主要原因,术中避免以上情况的发生并将漏入腹腔结石取净是避免术后并发症发生的关键。     

腹腔镜胆囊切除术中结石漏入腹腔的原因及处理

目的:探讨腹腔镜胆囊切除术(LC)中结石漏入腹腔发生的原因及预防。方法:回顾分析512例LC术中结石漏入腹腔发生的原因,探讨其预防措施及处理经验。结果:LC术中结石漏入腹腔32例,发生率为6.25%。LC术中结石漏入腹腔后多全部取出,腹腔残留结石患者无腹腔脓肿及窦道形成等并发症出现。结论:预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔,胆囊分破、结石落入腹腔后采取必要的处理措施,LC术中结石落入腹腔未能全部取出,可严密随访,不必为此中转开腹。     

腹腔镜胆囊切除术中结石漏入腹腔的处置体会

目的：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。方法：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。结论：预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔，胆囊分破、结石落入腹腔后采取必要的处理措施，随着LC术中腹腔漏入结石处理方式的改进，取石时间缩短，腹腔残石发生率大大降低。     

腹腔镜胆囊切除术结石漏入腹腔的原因及对策

近年来有关腹腔镜胆囊切除术 (ＬＣ)后腹腔残留结石引起腹腔脓肿、窦道形成个案报道甚多。本文拟对ＬＣ术后腹腔残留结石发生的原因、预防措施及处理方法进行探讨。1　临床资料我院 1992年 9月至 2 0 0 1年 9月共完成 72 0 0例ＬＣ术 ,其中慢性胆囊炎 6 4 13例 ,急性胆囊炎 713例 ,萎缩性胆囊炎 74例。本组病例共发生结石落入腹腔 36 3例 ,其发生率约为 5 % ,其中包括急性胆囊炎 16 8例 ,慢性萎缩性胆囊炎 6 4例 ,慢性胆囊炎 131例。其发生的原因为 :ＬＣ术中胆囊分破所致 2 18例 ,钳夹胆囊侧胆囊管的钛铗碰落 4 3例 ,自戳孔取出胆囊时撕破 …     

LC术中结石漏入腹腔的处置(附182例报告)

目的 :探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。方法 :回顾分析 10 86 5例LC术中发生结石漏入腹腔 346例 (3.18% )的原因及处置方式。结果 :346例结石漏入腹腔用传统取石方法取石 16 4例 ,用吹筒取石法取石 182例 ,后者取石时间明显缩短 ,腹腔残石发生率明显降低。结论 :预防漏入腹腔结石的关键是LC术中要防止分破或取出时撕破胆囊 ,以致胆汁、结石漏入腹腔。胆囊分破、结石落入腹腔后随着LC术中结石漏入腹腔处理方式的改进 ,取石时间缩短 ,腹腔残石发生率会明显降低。     

腹腔镜胆囊切除术并发症分析

目的探讨腹腔镜胆囊切除术(LC)并发症发生的原因及处理措施。方法回顾性分析13例LC并发症的原因、处理方法和预防措施。结果发生并发症13例(1.01%),其中胆管损伤3例,胆漏3例,胆总管残余结石5例,腹壁戳孔结石残留2例。13例均及时处理后治愈。结论腹腔镜胆囊切除术并发症重在预防,完善术前检查,重视术中术后的每个环节是减少LC并发症的关健。     

腹腔镜胆囊切除术后腹腔残留结石

腹腔镜胆囊切除术 (ｌａｐａｒｏｓｃｏｐｉｃｃｈｏｌｅｃｙｓｔｅｃｔｏｍｙ ,ＬＣ)因其创伤小、患者痛苦少、术后恢复快、手术切口较美观而广为医患所接受[1] 。作为一种新开展的外科治疗技术 ,其所引起的一些并发症尚不为大家所熟知。本文仅对其术后腹腔残留结石作一简要综述。一、ＬＣ术后腹腔残留结石的原因及发生率ＬＣ术后腹腔残留结石是由于游离胆囊管时将胆囊分破、解剖胆囊时电凝钩将其钩破或牵引钳将其撕破所致 ,自戳孔取出胆囊时用力过猛将其扯破或因戳孔过小扩开时血管钳将胆囊戳破亦是主要原因[2 ,3] 。杜景平等[4 ] 认为 :…     

腹腔镜胆囊切除术结石漏入腹腔的原因及处理

近年来，有关腹腔镜胆囊切除术（LC）后腹腔残留结石引起腹腔脓肿、窦道的报道较多，现回顾分析我院56例LC术中结石漏入腹腔的原因及处理方法如下。     

腹腔镜胆囊切除术戳孔并发症298例临床分析

我院1992年10月～2005年6月行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）9934例,发生戳孔并发症298例（3.0%）。其中戳孔感染248例,25例经扩创引流后痊愈,其余经通畅引流后痊愈;戳孔异物残留30例,20例为结石残留,9例为钛夹残留,1例为针头断裂残留,均经扩创取出异物后痊愈;戳孔疝18例,均经再次手术修补后痊愈;胃损伤1例,经胃肠减压等治疗后痊愈;腹腔大血管损伤1例,术中失血性休克死亡。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.