腹腔镜下小切口胆囊切除治疗早期急性胆囊炎的临床疗效及安全性分析

目的:分析腹腔镜下小切口胆囊切除治疗早期急性胆囊炎的临床疗效及安全性.方法:选取2018年3月至2020年3月期间于我院进行早期急性胆囊炎治疗的86例患者为本次研究对象,按不同手术方案将其分为研究组(n=43,采取腹腔镜下小切口胆囊切除术)和对照组(n=43,采取常规小切口胆囊切除术).记录两组患者手术情况及恢复情况,...     

术中胆道造影对腹腔镜胆囊切除手术效果的影响

目的研究术中胆道造影对腹腔镜胆囊切除手术效果的影响,以防治腹腔镜胆囊切除术后胆道损伤。方法临床入选102例行腹腔镜胆囊切除术患者,按照随机数字方法分成2组,每组51例,其中对照组患者在行腹腔镜胆囊切除术中未予以胆道造影,而研究组在行腹腔镜胆囊切除术中予以胆道造影。随访后,统计分析两组患者相关临床资料。结果与对照组相比较,研究组患者的出血量、手术时间、住院天数均显著减少（P〈0.05）。对照组有6例（11.76%）出现结石残余,9例（17.65%）胆管损伤,8例（15.69%）胆总管下端狭窄;研究组有1例（1.96%）出现结石残余,2例（3.92%）胆管损伤,2例（3.92%）胆总管下端狭窄,经统计学分析发现,两组患者在结石残余、胆管损伤、胆总管下端狭窄发生率方面具有统计学意义（P〈0.05）。结论术中胆道造影对腹腔镜胆囊切除手术具有积极的指导意义,建议将其作为腹腔镜胆囊切除手术的常规检查。     

出血致腹腔镜胆囊切除术中转开腹原因探讨-附3例报告

目的探讨腹腔镜胆囊切除术术中出血原因和处理办法。方法回顾分析1995年5月至2006年12月我院1000余例腹腔镜胆囊切除术中3例因术中出血导致中转开腹的临床资料。结果3例患者中转开腹后出血均得到有效控制,无术后并发症,治愈出院。结论出血是腹腔镜胆囊切除术中常见的并发症,如果腹腔镜胆囊切除术术中发生难以控制的出血,中转开腹是必要的措施,止血措施不当可能致严重的胆管损伤。     

腹腔镜胆囊切除术术后腹胀的原因及预防护理措施

目的 分析腹腔镜胆囊切除术术后腹胀的原因及预防护理措施.方法 回顾性分析我院手术室腹腔镜手术切除胆囊的病例,结合文献分析其相关原因及预防的护理措施.结果 术后有35例(23.3%)出现不同程度的腹胀,术后腹胀病例中均有合并既往病史,手术持续时间、住院平均时间长的共通特点.结论 严格把握手术的适应症,对病人的病情进行充分的评估,做好充分的术前护理准备工作,提高医务人员的技术熟练程度,能取得较为满意的效果.     

三孔操作腹腔镜胆囊切除术(1 500例报告)

目的探讨三孔操作腹腔镜胆囊切除术的方式方法,进一步提高腹腔镜操作技术.方法对1500例三孔操作腹腔镜胆囊切除术进行回顾性分析.结果1466例腹腔镜胆囊切除成功,34例中转开腹,均治愈出院.结论三孔操作腹腔镜胆囊切除是完全可行的,降低了对患者的创伤,使微创技术有了进一步提高.     

胆囊切除三种术式的治疗体会

胆囊切除三种术式为:传统胆囊切除术(CC)、小切口胆囊切除术(MC)、腹腔镜胆囊切除术(LC).首例胆囊切除术获得成功至今已有一百多年的历史,为安全、成功的经典手术.1982年法国Dubois为了减少手术创伤首先施行了小切口胆囊切除术.随着医疗技术的发展出现了腹腔镜胆囊切除术.为探讨三种术式的优劣点,1998年1月～2001年8月共150例胆囊切除术者分析如下.     

腹腔镜胆囊切除术438例术中及术后处理

目的；探讨腹腔镜胆囊切除术适应症的选择，术中注意事项，避免副损伤的技巧和术后并发症的处理原则。方法：对438例各类胆囊疾病行腹腔镜胆囊切除术术中情况及应变措施，术后发生胆汁瘘的处理方法和效果进行与总结。结果：中转开腹8例，术后开腹3例，术后胆汁瘘共12例，其中9例行保守治疗治愈。结论：慢性结石性胆囊炎引起的废用性胆囊选择腹腔镜手术要慎重，术中根据calot三角情况采用最佳处理方法，术后胆瘘在胆汁流量较少情况下可观察一周再决定是否开腹手术。     

Calot三角解剖与严重粘连患者腹腔镜胆囊切除术

目的：探讨Calot三角严重粘连患者腹腔镜胆囊切除术的手术方法。方法：选择1997--2002年采用腹腔镜胆囊切除术治疗的178例Calot三角严重粘连患者，进行回顾性分析。总结该手术方法的处理要点。结果：178例患者中170例顺利采用腹腔镜切除胆囊，8例中转开腹手术，中转率为4.5%，无一例出现并发症。结论：掌握Calot三角的解剖及其变异，严重粘连患者采用腹腔镜胆囊切除术是一种安全有效的手术方法。     

循证护理在患者行腹腔镜胆囊切除术后并发症中的应用研究

目的:探讨循证护理在预防患者行腹腔镜胆囊切除术后并发症中作用。方法:将80例行腹腔镜胆囊切除术的患者随机分成观察组(40例)和对照组(40例),观察组采用循证护理,对照组采用传统的护理方法,比较二者的护理效果。结果:观察组护理效果明显好于对照组,差异有统计学意义(P<0.05),如恶心和呕吐的发生率。结论:循证护理可以减少患者行腹腔镜胆囊切除术后并发症的发生,值得临床推广。     

126例腹腔镜胆囊切除术的护理体会

目的探讨腹腔镜胆囊切除术的护理措施及疗效。方法对我院126例行腹腔镜胆囊切除患者的临床资料、护理措施及护理效果进行回顾性分析。结果 126例行腹腔镜胆囊切除患者手术时间平均为45min;术中出血少,术后生命体征平稳,部分患者出现皮下气肿和呕吐;患者平均住院5d,均痊愈出院,术后恢复良好,生活工作正常。结论做好患者术前、术后护理和出院指导,是保证患者手术成功、早日康复的重要前提。     

Descending influence from the nucleus locus coeruleus/subcoeruleus on visceral nociceptive transmission in the rat spinal cord

Visceral nociceptive signals are the subject of descending modulation from the locus coeruleus/subcoeruleus (LC/SC). We have recently found dorsal horn neurons whose visceral nociceptive responses are not inhibited by the descending LC/SC system (LC/SC-unaffected neurons) in the rat. The aim of the present study was to estimate a possible role of LC/SC-unaffected neurons for pain processing and pain-related responses. We focused on the fact that nociceptive signals from a visceral organ produce not only visceral pain but also visceromotor reflexes (muscular defense). Different effects of LC/SC stimulation can be expected between visceral pain and visceromotor reflexes. To accomplish our objective, the descending colon was electrically stimulated, and both the evoked discharge (ED) in the ventral posterolateral (VPL) nucleus of the thalamus and the electromyogram (EMG) of the abdominal muscle were simultaneously recorded under halothane anesthesia. The ED recorded from the VPL was completely inhibited with the increase of LC/SC stimulus intensity, while the EMG of the abdominal muscle still remained even after the ED disappeared. This result suggests that the minimum visceromotor reflex responses are maintained by the presence of LC/SC-unaffected neurons, which play the important role of protecting the visceral organs. Considering a role of muscular defense, the presence of the LC/SC-unaffected neurons may be advantageous for the individual under an abnormal pain state, such as inflammation.     

Paucicellular and asymptomatic lymphocytic colitis: expanding the clinicopathologic spectrum of lymphocytic colitis

We examined clinicopathologic associations and biopsy changes that suggested classic lymphocytic colitis (C-LC) but were less well developed in intensity or distribution in 19 cases, which we termed paucicellular LC (P-LC). We also studied clinicopathologic associations and prevalence of LC in 100 asymptomatic, non-gluten-sensitive adults who underwent screening surveillance colonoscopy for previous adenoma. The control group was 38 randomly selected morphologically C-LC cases. The features of P-LC were foci of mildly increased lamina propria lymphoplasmacytic inflammation and increased surface intraepithelial lymphocytes separated by foci or tissue fragments of normal mucosa. Mean age and rates of female sex, endoscopically normal appearing colon, abdominal pain, watery stools, weight loss, connective tissue diseases, and consistent ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) were similar for P-LC and C-LC patients. Of 100 asymptomatic patients, 26 (26%) had LC and 43 (43%) used NSAIDs daily. Of these 43 patients, 14 (33%) had P-LC or C-LC. Daily NSAID ingestion was associated significantly with LC (P = .024). P-LC patients had clinicopathologic relationships similar to those of C-LC patients, suggesting they should be considered part of the morphologic spectrum of LC. LC in asymptomatic adults might be more common than previously thought and might not be associated with watery diarrhea syndrome.     

Clinical characteristics and follow-up of patients with AIDS and acute abdominal pain

Abdominal symptoms frequently affect patients with AIDS. Acute abdominal pain is a diagnostic challenge that may require elective or urgent surgical treatment, although information about the latter is scarce. In this study we analyzed the clinical findings and follow-up of acute abdominal pain complicating patients with AIDS. In a two-year period, we collected several variables from patients with AIDS and acute abdominal pain: demographic, laboratory, clinical symptoms, initial diagnosis, surgical findings, post-surgical and histopathological diagnosis and post-surgical complications. From 232 hospitalized patients, 34 had acute abdominal pain: 32 male and 2 women (median age = 32 years; range 26 to 58 years). Twenty-two patients required surgical treatment. Eight patients had a post-surgical complication; in five of them, six surgical re-interventions were performed. Three deaths occurred in the 30-day period after surgery. Survival for patients conservatively treated was 4 months (1 to 17 months), vs. 6.5 months (1 to 20 months) in the surgically treated group. Physicians should be aware about the several diagnostic possibilities of acute abdominal pain complicating patients with AIDS. Delay of surgery in these patients may be lethal. Surgery has an important role in the integral treatment of patients with AIDS.     

Sclerosing encapsulating peritonitis (abdominal cocoon) associated with liver cirrhosis and diffuse large B-cell lymphoma: Autopsy case

A case of sclerosing encapsulating peritonitis (SEP) associated with liver cirrhosis (LC) and complicated by diffuse large B-cell lymphoma (DLBCL) is reported herein. A 49-year-old Japanese man had undergone peritoneo-venous shunt against refractory ascites due to hepatitis C virus-positive uncompensated LC for 2 years. After he received a diagnosis of DLBCL of the left neck lymph node 3 months before his death, palliative care was given because of his poor general condition. He developed severe abdominal distention and pain over 1 week and was found to have marked ascites and whole bowel lumped together on abdominal CT. At autopsy, the peritoneum was covered with a thick white membrane and the bowel could not be distinguished, which was macroscopically characterized by a cocoon-like appearance. Histology indicated a proliferation of diffusely thickened or hyalinized fibrocollagenous tissue in the entire peritoneum with a slight chronic inflammatory infiltrate and without remarkable change of mucosa. A diagnosis of SEP, also known as abdominal cocoon, was established based on these features. Additionally, in the abdominal cavity, a large amount of serous ascites and multiple peritoneal nodules or masses involved by DLBCL were recognized. To the authors' knowledge this is the first case report of SEP associated with LC and complicated by the invasion of DLBCL in the abdominal cavity.     

Heterotopic pregnancies after in-vitro fertilization and embryo transfer--a Danish survey

Thirteen cases of heterotopic pregnancy were diagnosed among1171 pregnancies established in Denmark after in-vitro fertilizationand embryo transfer (IVF-ET). Thus the frequency of heterotopicpregnancy was 13/1171 or 1.1%. In five cases the diagnosis ofheterotopic pregnancy was made by ultrasound at 6–9 weeksof gestation; three of these patients were asymptomatic, whiletwo patients presented with abdominal pain and vaginal bleeding.All these patients had an unruptured ectopic pregnancy. Eightcases were diagnosed at the time of surgery; all these patientspresented with abdominal pain. Only two of the 13 patients hadvaginal bleeding. In nine of the 13 cases the intra-uterinepregnancy resulted in term delivery, while one pregnancy isongoing. In pregnancies following IVF-ET, this diagnosis shouldparticularly be considered in cases with abdominal pain; vaginalbleeding may be absent. Ultrasound examination may lead to earlydiagnosis even in asymptomatic cases. In most cases, removalof the ectopic gestation will allow the intrauterine pregnancyto proceed to term.     

内镜逆行胰胆管造影联合近期腹腔镜胆囊切除治疗胆系结石的可行性分析与体会

目的探讨经内镜逆行胰胆管造影（ERCP）联合近期（3 d内）腹腔镜胆囊切除术（LC）彻底治疗胆系结石的可行性。方法回顾性分析2012年1月至2014年1月首都医科大学附属北京天坛医院普通外科收治的胆囊结石胆囊炎合并胆总管结石及胆道感染的46例患者,ERCP后1-3 d内行LC的患者21例,设为实验组;ERCP后1-3个月行LC的患者25例,设为对照组。对比两组患者LC手术时间,术中出血量,术后腹腔引流量,中转开腹率,胆囊部分切除率,LC手术前后直接胆红素、谷丙转氨酶及血清淀粉酶含量。结果两组患者在手术时间、术中出血量、术后腹腔引流量、中转开腹率、胆囊部分切除率之间比较,差异无统计学意义（P=0.385、0.242、0.796、0.836、1.000）;实验组术前直接胆红素[（16.80±4.38）vs（7.86±3.35）,P=0.000]、谷丙转氨酶[（60.33±21.01）vs（45.66±19.69）,P=0.019]及血清淀粉酶值[（69.61±39.71）vs（45.70±16.67）,P=0.009]均高于对照组,术后两组间直接胆红素、谷丙转氨酶、血清淀粉酶比较,差异无统计学意义（P=0.365、0.114、0.316）。结论 ERCP联合近期内行LC彻底治疗胆系结石是可行的。掌握此时期手术的所需技巧,可以达到安全、尽早彻底治疗患者胆系结石及炎症。     

Negative life events and symptom resolution in pediatric abdominal pain patients

Investigated relation of negative life events (NLE) to initial symptom severity and symptom resolution at 3 months in 2 patient groups: (a) recurrent abdominal pain (RAP) without identifiable organic etiology, (b) abdominal pain with organic diagnosis. Symptoms assessed were abdominal pain, somatization symptoms, anxiety, depression. Number of NLE was positively correlated with anxiety and depression in both groups at clinic visit. NLE predicted resolution of abdominal pain for RAP patients only; RAP patients with more NLE prior to or following the clinic visit were more likely to maintain their abdominal pain. More NLE following clinic visit was associated with maintenance of anxiety and somatization symptoms at follow-up in RAP patients. Results suggest a measure of NLE is not useful in differential diagnosis of patients with and without organic findings, but is useful in predicting outcome in patients without organic findings.     

Pain Characteristics after Total Laparoscopic Hysterectomy

Background. Total laparoscopic hysterectomy (TLH) causes various types of postoperative pain, and the pain pattern has not been evaluated in detail to date. This prospective observational study investigated the types of postoperative pain, intensity in the course of time, and pain characteristics during the first postoperative 72 hr after TLH.Methods. Sixty four female patients undergoing TLH were enrolled, which finally 50 patients were included for the data analyses. The locations of pain included overall pain, abdominal visceral and incisional pains, shoulder pain, and perineal pain. Assessments were made at rest and in motion, and pain level was scored with the use of the 100 mm visual analog scale. The pain was assessed at baseline, and at postoperative 30 min, 1 hr, 3 hr, 6 hr, 24 hr, 48 hr, and 72 hr.Results. Overall, visceral, and incisional pains were most intense on the day of operation and then decreased following surgery. In contrast, shoulder pain gradually increased, peaking at postoperative 24 hr. Shoulder pain developed in 90% of all patients (44/50). It was not more aggravated in motion than at rest, in comparison with other pains, and right shoulder pain was more severe than left shoulder pain (p=0.006). In addition, the preoperative exercise habit of patients increased the threshold of shoulder pain. Most patients (46/50) had perineal pain, which was more severe than abdominal pain in approximately 30% of patients (17/50).Conclusion. Pain after TLH showed considerably different duration, severity, and characteristics, compared with other laparoscopic procedures. Shoulder pain was most intense at postoperative 24 hr, and the intensity was associated with the prior exercise habit of patients and the high level of analgesic request.     

Validation of a symptom provocation test for laboratory studies of abdominal pain and discomfort in children and adolescents

OBJECTIVE: Assessed the convergent and discriminant validity of a water load symptom provocation test (WL-SPT) in creating visceral sensations similar to the naturally occurring sensations experienced by children with functional abdominal pain. METHODS: Participants were pediatric patients with functional abdominal pain (N = 110) and healthy school children (N = 120) between the ages of 8 and 16 years. Pain patients completed questionnaires describing gastrointestinal (GI) and non-gastrointestinal (non-GI) symptoms associated with their typical abdominal pain episodes. Weeks later, the WL-SPT was administered to pain patients and well children. Before and immediately following the WL-SPT, children rated their symptoms. RESULTS: The WL-SPT produced (a) significant increases in children's GI symptoms that were reliably predicted by the children's naturally occurring GI symptoms, and (b) significantly greater increases in GI symptoms in pain patients than in well children. CONCLUSIONS: The WL-SPT produces clinically relevant symptoms for laboratory studies of children with functional abdominal pain.