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随着电视腹腔镜胆囊切除手术(LC)的普及运用,其手术创伤小,术后疼痛轻、恢复快、住院时间短等优点,使得临床外科医生及广大患者越发体会到其优越性。自2002年12月至2003年9月共开展电视腹腔镜胆囊切除手术治疗胆囊炎合并胆囊结石或胆囊息肉病患者共镐例,取得了满意疗效,现报告如下: 相似文献
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自 1991年 12月开展L C到 2 0 0 0年 12月已行腹腔镜胆囊切除术 72 4 8例 ,发现异位胆囊 11例 ,占同期L C的0 .15 % ,均行L C完成胆囊切除 ,虽操作遇到困难 ,但经过顺利。1 临床资料和方法1.1 一般资料 11例中 ,男 3例 ,女 8例 ;年龄 2 6~ 6 4岁 ;全内脏反位 1例 ,右肝发育异常胆囊位于右后位 1例 ,胆囊横跨肝方叶、左外叶脏面 4例 ,胆囊位于左外叶下面 5例11例均为结石性胆囊炎患者 ,拟行L C入院 ,除全内脏反位术前明确异位胆囊外 ,其余均在术中发现异位胆囊。1.2 方法 造气腹及置镜同正常L C ,肋缘下Trocar穿刺孔… 相似文献
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我院自1995年2月至1999年4月施行腹腔镜胆囊切除术420例,其中男152例,女268例,年龄2l~82岁。420例中,胆囊息肉82例,慢性胆囊炎、胆囊结石315例,急性胆囊炎伴胆囊结石3例。手术时间30~150分钟。术中转开腹8例中,1例因胆囊动脉出血,1例诊断有误(胆囊癌).1例因胆管损伤,另5例均为胆囊三角解剖不清。 相似文献
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目的:提高腹腔镜胆囊切除术至胆管损伤的预防水平。方法:回顾分析2002年至2004年306例腹腔镜胆囊切除术。结果:未发生胆管损伤。结论:深刻认识腹腔镜胆囊切除术致胆管损伤的原因,正规的人员培训,严守手术操作规范是预防腹腔镜胆囊切除术致胆管损伤的关键。 相似文献
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Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases. 相似文献
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The aim of this study was to describe three cases of major vascular injuries after laparoscopic cholecystectomy depicted on
magnetic resonance (MR) examination. Three female patients (mean age, 32 years; range, 22–39 years) were studied with clinical
suspicion of bilio-vascular injuries after laparoscopic cholecystectomy. All MR examinations were performed within 24 h after
the laparoscopic procedure. MR imaging was evaluated for major vascular injuries involving the arterial and portal venous
system, for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid and collections.
In the first patient, a type-IV Bismuth injury with associated intrahepatic bile ducts dilation was observed. Contrast-enhanced
MR revealed lack of enhancement in the right hepatic lobe due to occlusion of the right hepatic artery and the right portal
branch. This patient underwent right hepatectomy with hepatico-jejunostomy. In the other two cases, no visualization of the
right hepatic artery and the right portal branch was observed on MR angiography. In the first case, the patient underwent
right hepatectomy; in the second case, because of stable liver condition, the patient was managed conservatively. MR imaging
combined with MR angiography and MR cholangiography can be performed emergently in patients with suspicion of bilio-vascular
injury after laparoscopic cholecystectomy allowing the simultaneous evaluation of the biliary tree and the hepatic vascular
supply that is essential for adequate treatment planning. 相似文献
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目的观察麻醉诱导前静脉预输注不同剂量盐酸右美托咪啶注射液(dexmedetomidine hydrochloride injection,Dex)对腹腔镜胆囊切除手术患者围术期血流动力学的影响。方法选择美国麻醉协会Ⅰ级或Ⅱ级择期行腹腔镜胆囊切除手术的患者76例,随机双盲分成4组,分别为空白对照组(C组,诱导前静脉预输注0.9%的氯化钠溶液)、小剂量Dex组(L组,预输注Dex 0.6μg/kg,10 min)、中剂量Dex组(M组,预输注Dex 0.8μg/kg,10 min)和高剂量Dex组(H组,预输注Dex 1.0μg/kg,10 min),每组19例。分别于输注Dex前(T0)、输注Dex 10 min后(T1)、气管插管即刻(T2)、气管插管后1 min(T3)、气腹后10 min(T4)、气管拔管即刻(T5)记录患者的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和心率(heart rate,HR)。结果与T0时比较,T1时M组和H组HR均降低,H组SBP、DBP升高(P<0.05);与T1时比较,T2时C组和L组SBP、DBP和HR降低,T3~T5时SBP、DBP和HR升高(P<0.05);与M组比较,T1~T5时H组SBP、DBP升高(P<0.05)。结论麻醉诱导前静脉预输注右美托咪啶剂量0.8μg/kg,可有效维持腹腔镜胆囊切除手术患者的血流动力学稳定,减轻二氧化碳气腹下腹腔镜手术患者的应激反应。 相似文献
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瑞芬太尼复合异丙酚全静脉麻醉用于腹腔镜胆囊切除手术的临床研究 总被引:3,自引:1,他引:2
目的评价瑞芬太尼复合异丙酚全静脉麻醉用于腹腔镜胆囊切除手术时对血流动力学、术后恢复时间及脑动-静脉血氧含量差的影响.方法 ASAⅠ-Ⅱ级,择期行腹腔镜胆囊切除手术的患者30例,随机分成静脉全麻组(R组)和静吸复合麻醉组(Ⅰ组),于手术各时点分别检测血流动力学指标,并测定动静脉血气,计算脑动-静脉血氧含量差,并比较术后恢复时间.结果气管插管后Ⅰ组血流动力学变化比R组大(P<0.05),R组术后恢复时间明显低于Ⅰ组(P<0.05),气腹后R组脑动-静脉血氧含量明显低于Ⅰ组(P<0.05),两组术后VAS评分没有明显差别(P>0.05).结论瑞芬太尼复合异丙酚全静脉麻醉降低血流动力学变化,降低脑动-静脉血氧含量的升高,可能有利于腹腔镜胆囊切除手术时脑的保护. 相似文献
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目的:探讨胆囊管综合征(cystic duct syndrome,CDS)的诊断方法及治疗措施.方法:回顾分析36例CDS的临床症状、诊断流程及治疗结果.结果:36例CDS均具有典型的胆绞痛症状.术前常规进行腹部超声、口服胆囊造影等检查,21例行MRCP检查提示胆囊管迂曲、慢性胆囊炎或胆囊积液.12例病程中发现继发性胆囊结石.合并急性化脓性胆囊炎6例.31例顺利实施腹腔镜胆囊切除术,其中2例行经脐单孔腹腔镜胆囊切除术.5例实施开腹胆囊切除术.术中所见及术后病理学检查均支持CDS的诊断.结论:CDS的诊断需综合考虑临床症状、影像学检查、术中发现及术后病理学检查等因素,腹腔镜胆囊切除术是CDS的理想治疗方法. 相似文献
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Sepsis from dropped clips at laparoscopic cholecystectomy 总被引:2,自引:0,他引:2
We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis. 相似文献
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目的:探讨内镜对胆囊切除术后胆总管下端狭窄的诊断及治疗价值。方法:89例胆囊切除术后综合征患者行内镜下逆行胰胆管造影(ERCP)。对发现的38例(43%)胆总管下端狭窄患者行内镜下乳头括约肌切开术(EST)等内镜治疗。结果:上腹痛缓解率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为94.74%、78.83%、88.75%,胆总管内径恢复率在单纯胆总管下端狭窄者、合并急性胰腺炎者、合并结石者分别为100%、92.69%、100%,术后所有患者血ALT,AST,ALP及GGT恢复正常。结论:EST是治疗胆总管下端狭窄有效和首选的治疗方法。 相似文献
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目的:探讨磁共振胰胆管水成像(MRCP)对腹腔镜胆囊切除术(LC)后发生胆囊切除综合征(PCS)的诊断价值。方法:对比分析26例LC术后出现PCS和11例未出现PCS的患者的MRCP表现。结果:PCS组的胆总管扩张的发生率为65.38%(17/26),对照组为18.18%(2/11)。PCS组的胆囊管残留过长的发生率为53.85%(14/26),对照组为18.18%(2/11)。PCS组胆道结石的发生率为30.76%(8/26),对照组为0%(0/11)。PCS组1例(3.84%)有胆总管狭窄,对照组没有。结论:对于诊断LC术后出现的PCS,MRCP是一种十分有效的检查方法。 相似文献