腹腔镜胆囊切除术对机体炎症免疫反应的影响

目的:对比研究腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)和开腹胆囊切除术(open choleaptectomy,OC)对机体炎症免疫反应的影响.方法:检测胆囊结石患者(LC及OC各30例)术前、术后1 h、术后1 d、术后2 d的外周血T淋巴细胞亚群、WBC计数、C反应蛋白(C-reactive protein,CRP)及白介素-6(IL-6)的变化并进行对比研究.IL-6值的检测用酶联免疫吸附法(ELISA),T细胞亚群用流式细胞仪检测.结果:OC组术后2 d,成熟T淋巴细胞(CD3)、辅助性T淋巴细胞(CD4)、CD4/抑制性T淋巴细胞(CD8)比值较术前下降(P<0.05),且同LC组相比较,OC组明显低于LC组(P<0.01).OC组术后1 d或/和术后2 d WBC计数、CRP、IL-6均较术前明显升高(P<0.01),且与LC组相比较,OC组明显高于LC组(P<0.01).结论:LC对机体炎症免疫反应影响小,有利于LC术后的恢复.     

腹腔镜胆囊切除术对机体免疫功能的影响

目的：比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法：随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组（laparoscopic cholecystectomy,LC组）和开腹胆囊切除组（open cholecystectomy,OC组）各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3^＋（T细胞总数）、CD4^＋（T辅助/诱导细胞）和CD8^＋的数量。结果：两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3^＋、CD4^＋、CD8^＋与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3^＋、CD4^＋、CD8^＋均明显低于LC组。结论：腹腔镜手术对机体的免疫功能影响小,术后恢复快。     

腹腔镜胆囊切除术对机体影响的研究进展

与开腹胆囊切除术（open cholecystectomy，OC）相比，腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）具有创伤小、痛苦轻、恢复快等特点，目前已将LC作为胆囊切除的首选术式。在普及和提高腹腔镜手术的同时，开展了腹腔镜手术的临床与基础研究，取得一定的成果。现就LC对机体影响的研究状况作一综述。     

腹腔镜胆囊切除术对甲状腺功能影响的观察

对比观察腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)对甲状腺功能的影响。随机选择60例慢性胆囊炎并胆囊结石患者，分为三组，分别在全麻下施行LC和OC及硬膜外麻醉下行OC。于术前、术后3h、术后次日展采取静脉血标本，用放射免疫法测定血清总T3、T4、TSH浓度。结果：总T3、T4在3组间变化无显著性差异，而TSH在LC组术后无变化，在OC两组则显著降低，提示LC在一定程度上对甲状腺功能的影响较OC小，反映LC对机体的创伤应激反应减轻。     

腹腔镜胆囊切除术对机体代谢炎症反应的影响

本文选择１９９６年１２月至１９９７年７月期间行腹腔镜胆囊切除术（ＬＣ）和开腹胆囊切除术（ＯＣ）的部分病人，对其术前、术后炎症和代谢反应的部分指标进行观察，以较全面了解ＬＣ对机体代谢及炎症反应的影响。１材料和方法１１临床资料６０例因患慢性胆囊炎、胆囊...     

腹腔镜胆囊切除术对机体红细胞免疫功能和T淋巴细胞亚群的影响

目的 :探讨腹腔镜胆囊切除术 (LC)对机体红细胞免疫功能和T淋巴细胞亚群的影响。方法 :以红细胞C3 b受体花环率、红细胞免疫复合物花环率、肿瘤红细胞花环率及CD3、CD4、CD8细胞作为观测指标 ,测定 6 0例LC患者术前、术后第 1天和第 3天免疫指标的变化。结果 :LC患者术后第 1天的上述免疫指标虽有轻度障碍 ,但没有显著性意义 ,且术后第 3天迅速恢复。结论 :LC患者手术前后红细胞免疫功能和T淋巴细胞免疫功能没有明显障碍 ,是患者术后能迅速康复的免疫依据     

腹腔镜胆囊切除术与开腹胆囊切除术对肝功能影响的比较研究

目的 对腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）手术前后肝功能的临床资料进行对比研究，旨在观察术后肝功能变化规律及两种术式对肝功能的影响有无差异，并为今后手术病例及术式选择提供依据。方法 选择胆囊良性病变且肝功能正常需行胆囊切除术者作为研究对象。将30例病人分为LC组和OC组，并分别按开放法或腹腔镜方法实施胆囊切除术。术前、术后第1、3、7天，分别取空腹外周静脉血测定肝功能指标，包括ALT、AST、TBIL、DBIL、GGT、ALB、ALP。结果 两组病人年龄构成及术前肝功能无显著差异，LC与OC术后各项指标变化趋势相同。LC与OC术后血清ALT、AST、TBIL均较术前升高；上述指标术后第3天即明显下降，至术后第7天达正常水平，且所有病人术后顺利恢复。LC与OC术后血清ALB均有下降，血清DBIL、GGT、ALP均无显著变化。结论 本研究结果表明：（1）LC与OC对肝功能均有影响，但仅为一过性现象，不影响病人恢复；（2）在全麻下，腹腔内气腹压力为12～15mmHg时，LC对肝功能的影响与OC相比无显著性差异，说明在此情况下施行LC是安全的。     

腹腔镜胆囊切除术和开腹胆囊切除术安全性临床分析

目的比较开腹胆囊切除术和腹腔镜胆囊切除术的安全性。方法回顾分析568例胆囊切除术病例。分为2组:A组为对照组,323例行开腹胆囊切除术;B组为实验组,245例行腹腔镜胆囊切除术。对比2组的手术成功率、手术时间、住院时间、术中及术后并发症发生情况。2组手术成功率之间比较用检验,2组手术时间和住院时间之间比较用t检验,P0.05差异有统计学意义。结果2组手术成功率之间,P0.05,差异无统计学意义;2组手术时间和住院时间之间比较,P0.05差异有统计学意义。结论术前正确选择病例、术中规范操作、术后注意观察可能出现的并发症是腹腔镜胆囊切除手术成功的关键。相比开腹手术而言,具有明显的优势。     

腹腔镜胆囊切除术与开腹胆囊切除术的临床比较研究

目的比较腹腔镜胆囊切除术与开腹胆囊切除术的疗效和安全性。方法将我院2008年6月～2010年6月收治的96例胆囊疾病患者随机分为观察组（腹腔镜胆囊切除术）和对照组（开腹胆囊切除术）各48例,术后比较两组的手术时间、术中出血量、术后排气时间及并发症情况。结果观察组的手术用时、排气时间、住院时间明显短于对照组（P〈0.05）,且观察组术中出血量明显少于对照组（P〈0.05）,术后观察组1例因胆囊三角区出血,镜下止血失败而中转开腹;1例术后伤口出现感染,对照组出现切口感染4例,胆心反射5例,切口出血4例,胆管损伤、肠粘连各1例,观察组术后并发症的发生率明显低于对照组并发症的发生率（P〈0.05）。结论腹腔镜胆囊切除术与传统开腹手术相比对患者损伤小,术后恢复快,住院时间短,但也存在一些术后并发症,但并发症的发生率较低。     

腹腔镜胆囊切除术的判别函数研究

目的：研究腹腔镜胆囊切除术(LC)的判别函数，用以指导胆囊切除病例在术前确定选用LC或开腹胆囊切除(OC)的手术方法。方法：实施408例LC，术前对每一例的33项招标进行逐一登记，术后采用逐步判别分析进行招标筛选，求出LC判别函数。结果：筛选出有判别意义的7项招标，在Bayes准则下求出二个判别函数。回代函数结果，总的判别正确率为95．1％。结论：凡胆囊切除术病例只要在术前将7项招标代入函数中，即可在术前确定该病例选用LC或是OC。     

腹腔镜与开腹胆囊切除术对比分析

我院于1994年8月～1996年6月完成腹腔镜胆囊切除术(LC)70例,为了客观地评价LC的优越性及不足之处,本文随机将1993年7月～     

A financial analysis of laparoscopic and open cholecystectomy

Laparoscopic cholecystectomy (LC) is now the method of choice in treatment of symptomatic gallstone disease. Despite its rapidly growing popularity, comparative costs of this new method and open cholecystectomy (OC) remain unclear. The most outstanding feature of laparoscopic cholecystectomy is the period of short recovery. In Sweden the social insurance office documents sick leave period, sickness allowance, as well as diagnosis and therefore provides a reliable basis for an economic analysis. The purpose of this study was to estimate the hospital cost and costs due to sick leave in a series of patients operated on with elective cholecystectomy using the two methods. In each group 50 consecutive patients were studied retrospectively. The total hospital cost was 10% lower in the laparoscopy group—$1,864 as compared to $2,030 per patient in the OC group. Median number of days off work was 14 after LC and 35 days after open surgery, which corresponds to a median sickness allowance of $516 per patient (LC) compared to $1,424 (OC). Laparoscopic cholecystectomy is more cost-effective than open cholecystectomy mainly due to a reduced sick leave period.     

Giant gallstone performed by emergency laparoscopic cholecystectomy

INTRODUCTIONGallstone disease is very common, but the gallstone bigger than 5 cm in diameter is very rare. It is very challenging to be removed by laparoscopic cholecystectomy (LC) and poses extra difficulty in emergency.PRESENTATION OF CASEA 70-year-old man complained of abdominal pain in the right upper quadrant with fever of 38 °C for two days. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large gallstone (95 mm × 60 mm × 45 mm). Emergency laparoscopic cholecystectomy was performed successfully.DISCUSSIONGallstone over 5 cm in diameter is very rare. LC will be very difficult for these cases, especially for the emergency cases. Emergency laparoscopic cholecystectomy can be successfully performed with clear exposure of the anatomy of the Calot's triangle. To the best of our knowledge, such giant gallstone has been rarely reported.CONCLUSIONWe have proven that for the rare giant gallstone about 10 cm in size, LC is a feasible option if the anatomy of the Calot's triangle can be clearly exposed; otherwise, open cholecystectomy is a safe choice.     

Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis. However, the rate of conversion to open cholecystectomy remains higher when compared with patients with chronic cholecystitis. Preoperative clinical or laboratory parameters that could predict the need for conversion may assist the surgeon in preoperative or intraoperative decision making. This could have cost-saving implications. METHODS: A retrospective review of 46 patients undergoing laparoscopic cholecystectomy for acute cholecystitis was performed. Records were assessed for preoperative clinical, laboratory and radiographic parameters on admission. Temperature and laboratory parameters were also recorded prior to surgery after an initial period of hospitalization that included intravenous antibiotics. The effect of admission and preoperative parameters as well as the trend in these parameters prior to surgery upon the rate of conversion to open cholecystectomy was assessed. RESULTS: Ten patients (22%) required conversion to open cholecystectomy. Conversion was required more often in males (43%) when compared with females (4%) (p=0.003). Conversion rate was 30% in patients with increased wall thickness by ultrasound compared with 12% for patients without wall thickening (p=ns). No admission or preoperative laboratory values predicted conversion. The trend in the patient's temperature (p=0.0003) and serum LDH value (p=0.043) predicted the need for conversion to open surgery. CONCLUSIONS: Preoperative prediction of the need for open cholecystectomy remains elusive. Male patients and patients with rising temperature and LDH levels while on intravenous antibiotics require conversion at increased frequency. However, the benefits of laparoscopic cholecystectomy warrant an attempt at laparoscopic removal in most patients with acute cholecystitis.     

腹腔镜胆囊切除术与开腹胆囊切除术的临床特征及住院费用的对比

目的 对腹腔镜胆囊切除术的安全性，临床及经济价值作出评估。方法 对行ＬＣ的２７８例患者与开腹胆囊切除术的２３４例患者进行对比调查。结果 ＬＣ与ＯＣ具有相同的安全性；ＬＣ患者术后总的疼痛时间与严重疼痛时间，住院及出院后恢复工作的时间均明显短于ＯＣ患者；     

The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis

BACKGROUND: The risk of damage to the bile duct and structures in the hilum of the liver is significant when Calot's triangle cannot be safely dissected during laparoscopic cholecystectomy, and conversion to an open procedure often is performed. This is more common during emergency surgery, but may not render the procedure any easier. Traditionally, open subtotal cholecystectomy was performed, but with the advent of laparoscopic surgery, this has fallen from favor. The authors report their experience using laparoscopic subtotal cholecystectomy to avoid bile duct injury and conversion in difficult cases. METHODS: Laparoscopic subtotal cholecystectomy, performed when the cystic duct cannot be identified safely, consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain into Hartmann's pouch. The notes for all patients who underwent a laparoscopic subtotal cholecystectomy between 1 September 2001 and 31 December 2004 were retrospectively analyzed. RESULTS: Subtotal cholecystectomy was performed in 26 cases including 13 emergency and 13 elective procedures. The median age of the patients (15 women and 11 men) was 68 years (range, 36-86 years). The indications were severe fibrosis in 16 cases, inflammatory mass or empyema in 8 cases, and gangrenous gallbladder or perforation in 2 cases. The median postoperative inpatient stay was 5 days (range, 2-26 days). Five patients underwent postoperative endoscopic retrograde cholangiopancreatography: four for persistent biliary leak and one for a retained common bile duct stone. One patient required laparotomy for subphrenic abscess, and one patient (American Society of Anesthesiology [ASA] grade 4, presenting with biliary peritonitis) died 2 days postoperatively. One patient required a subsequent completion laparoscopic cholecystectomy for a retained gallstone. One patient had a chest infection, and two patients experienced port-site hernias. CONCLUSIONS: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot's triangle cannot be dissected. It averts the need for a laparotomy.     

Conversion of laparoscopic to open cholecystectomy

Background: Identifying patients who are at risk for conversion from laparoscopic (LC) to open cholecystectomy (OC) has proven to be difficult. The purpose of this review was to identify factors that may be predictive of cases which will require conversion to laparotomy for completion of cholecystectomy. Methods: We reviewed 581 LCs initiated between July 1990 and August 1993 at a university medical center and recorded reasons for conversion to OC. Statistical analysis was then performed to identify factors predictive of increased risk for conversion. Results: Of the 581 LC initiated, 45 (8%) required OC for completion. Reasons for conversion included technical and mandatory reasons and equipment failure. By multivariate analysis, statistically significant risk factors for conversion included increasing age, acute cholecystitis, a history of previous upper abdominal surgery, and being a patient at the Veterans Affairs Medical Center (VAMC). Factors not increasing risk of conversion included gender and operating surgeon. Conclusions: We conclude that no factor alone can reliably predict unsuccessful LC, but that combinations of increasing age, acute cholecystitis, previous upper abdominal surgery, and VAMC patient result in high conversion rates. Patients with the defined risk factors may be counseled on the increased likelihood of conversion. However, LC can be safely initiated for gallbladder removal with no excess morbidity or mortality should conversion be required.     

Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy

In an attempt to quantify the difference in tissue damage between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), we have compared in a prospective manner the pre- and postoperative concentrations of serum C-reactive protein (CRP) in 17 patients undergoing LC and 13 patients undergoing OC. In addition, we measured the pre- and postoperative white blood cell counts (WBC), the postoperative body temperature, and the postoperative duration of hospitalization. There were no differences in the preoperative serum CRP concentrations—5.9±2.62 mg/l (mean±SD) for the LC group and 6.12±2.38 mg/l for the OC group.Serum CRP rose markedly following OC compared to that of patients who underwent LC (128.6±45.1 mg/l vs 26.8±10.5 mg/l) (P<0.001). There were also significant differences in the postoperative WBC count (14,000±2,900 cells for the OC group vs 10,600±3,000 cells for the LC group), the postoperative body temperature (37.5±0.3°C vs 37.0±0.3°C), and the postoperative hospital stay (5.5±1.5 days vs 1.9±0.9 days). There was no correlation between serum CRP concentrations and the other postoperative parameters.These results provide us with biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.     

Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement

To evaluate the benefits and safety of laparoscopic cholecystectomy (LC) in patients with cardiac valve replacement (which frequently leads to cholelithiasis), 12 patients with cholelithiasis associated with cardiac valve replacement were studied. The patients were divided into two groups, of 6 patients each, according to the type of operation performed, open cholecystectomy (OC) or LC. The postoperative course was monitored with respect to laboratory data on postoperative days (POD) 1, 3, and 7. The mean duration of operation, blood loss, days to food resumption, length of hospital stay, and morbidity were compared between the two groups. Significant differences (P < 0.05) were found between the OC and LC groups in white blood cell counts on POD 1 (12 980 ± 3040/mm³ vs 8300 ± 1590/mm³), days to food resumption (2.7 ± 0.4 days vs 1.0 ± 0.7 days), and length of postoperative stay (15.8 ± 1.0 days vs 10.8 ± 1.6 days). There were no complications in the LC group, but 1 patient in the OC group had heart failure postoperatively. Our findings indicate the efficacy and safety of LC in patients with cardiac valve replacement. Received: August 14, 2000 / Accepted: December 22, 2000