Laparoscopic cholecystectomy]

Two hundred and fifty consecutive patients with symptomatic gallstones underwent elective laparoscopic cholecystectomy over a ten month period. Out of 250 cases, 2 (0.8%) were converted to open cholecystectomy. One was due to bleeding, and the other being due to severe adhesion. The remaining 248 cases resulted in complete success without any complications or postoperative readmission. In this modality of laparoscopic cholecystectomy, there is an apparent learning experience which can be covered only by adequate training and experience. From an ethical point of view, however, training should not be undertaken at the expense of patients. With less experienced operators, the threshold of indication for laparoscopic cholecystectomy should be set high in order to secure the safety of the patients as well as the successful completion of the procedures.     

Laparoscopic cholecystectomy.

Judith presented with a long-standing history of right upper quadrant pain which was found to be the result of cholelithiasis. She was treated by means of a laparoscopic cholecystectomy and underwent an uneventful recovery apart from complaining of tiredness. This may have been due to chronic overstrain caused by trying to cope with the needs of her family and her two elderly parents. Her problems stemmed from uncertainty about the procedure and worry about how her husband would cope while she was recovering. Both problems were resolved by explanation and discussion, bringing in other family members to support her so that her feelings of guilt could be recognized and dealt with. To date, she continues to make a good recovery and is keen to resume her normal family role.     

Laparoscopic ultrasound and cholecystectomy

Summary

The technique and usefulness of laparoscopic ultrasound examination of the biliary tree during cholecystectomy is described.     

萎缩性胆囊炎的腹腔镜治疗

目的探讨萎缩性胆囊炎的腹腔镜治疗方法，预防胆管损伤并发症的发生。方法回顾萎缩性胆囊炎59例的临床资料。结果59例萎缩性胆囊炎3例中转剖腹胆囊切除，41例放置腹腔引流管，术后肝下积液1例。无其他并发症及死亡病例。结论萎缩性胆囊炎的腹腔镜治疗与手术者的经验相关，必须重视经验的积累，多种手术技巧并用，操作耐心，把握好中转手术的时机，合理使用器械及做好围术期准备。     

Laparoscopic cholecystectomy: operative technique.

Laparoscopic cholecystectomy has become the routine procedure for most patients with symptomatic cholelithiasis. At our institution, a two-surgeon, four-cannula technique is used. In almost all patients, a pneumoperitoneum can be established with use of a closed technique. Adherence to standard operative principles and careful attention to details in the laparoscopic technique will routinely result in the safe completion of laparoscopic cholecystectomy. Cautery provides excellent hemostasis during dissection of the gallbladder from its attachments. Cholangiography through the gallbladder or the cystic duct is easily performed in selected patients. Minimal perioperative care is necessary for patients who undergo laparoscopic cholecystectomy, and the hospitalization time is usually less than 24 hours.     

腹腔镜胆囊切除术治疗急性结石性胆囊炎

目的总结腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床经验与价值。方法应用腹腔镜手术设备与器械为86例急性结石性胆囊炎病例实施了手术治疗。结果腹腔镜胆囊切除术71例，腹腔镜胆囊大部切除术10例，术中中转开腹手术5例，均无胆漏、胃肠道损伤、胆管损伤等严重手术并发症。结论腹腔镜胆囊切除术治疗急性结石性胆囊炎是安全可行的，适时中转开腹手术，是避免发生胆管等组织器官损伤、降低手术并发症的关键措施。     

腹腔镜胆囊切除转腹的原因探讨及预防

目的 探讨腹腔镜下复杂胆囊切除手术中转开腹的危险因素，提出预防措施。方法 对Lc中转开腹25例和对照组50例进行研究，选发病长短急性炎症史、胆囊炎症粘连肿大等14种因素进行调查用单因素及多因素分析找出危险因素。结果 急性炎症史等8种因素危险度（OR）3．86～17．11，95％可信区间（95％CI）1．375～23．539，经χ^2检验P〈0．05，为LC中转开腹的主要危险因素。结论 反复发作腹痛、发热、血象高等是急性炎症的临床表现，炎症渗出组织交性坏死是引起局部粘连水肿的病理基础，出血渗血又加重手术难度，胆囊三角炎症粘连水肿与肝门部及胆总管关系欠清及腹腔粘连是引起转腹的主要原因。     

腹腔镜胆囊切除术408例分析

目的：分析腹腔镜胆囊切除术并发胆管损伤的原因,结合文献探讨如何避免损伤。方法：回顾性分析我科1998年1月－2000年12月腹腔镜胆囊切除术408例资料。结果：408例腹腔镜胆囊切除术中胆管横断1例,术中发现并剖腹行胆总管断端吻合T管引流。结论：胆道损伤是LC的严重并发症、损伤部位和 程度不同,诊断和治疗也不同,其后果对病人和术者都是灾难性的。     

Laparoscopic cholecystectomy as trendsetter in minimal-invasive surgery

Only 10 years after the introduction of laparoscopic cholecystectomy in 1986 this method has become the "gold-standard" in the treatment of uncomplicated and complicated gallbladder disease. Laparoscopic cholecystectomy was so successfull, that it became the trendsetter in minimal-invasive surgery leading to revolutionary changes in all fields of surgery. Although nowadays self-evident, minimal-invasive surgery passed through a protracted and hindrance history of development. In this article we will review the history of laparoscopy and laparoscopic cholecystectomy and discuss its influence in the development of minimal-invasive surgery.     

有腹部手术史的腹腔镜胆囊切除术

目的 总结有腹部手术史的腹腔镜胆囊切除术(LC)的临床经验.方法 对286例有腹部手术史的腹腔镜胆囊切除术的临床资料进行分析.结果 248例顺利完成腹腔镜手术,38例中转开腹手术.其中因建立气腹困难17例、胆囊Calot三角区解剖不清12例、手术副损伤9例.全部病例均临床治愈.结论 有腹部手术史的LC难度较大,有一定风险.但是,正确选择穿刺孔,建立有效的气腹空间,掌握娴熟的腹腔镜操作技术和丰富的胆管手术经验,注意防范手术各环节可能造成的副损伤,顺利完成腹腔镜手术是安全、可行的.手术效果明显优于开腹手术.     

Laparoscopic cholecystectomy: Intraoperative cholangiography made easy

Summary. One of the reasons for the decline in use of cholangiography during laparoscopic cholecystectomy is the perceived technical difficulty of performing the procedure and its associated increase in operating time. We report the use of a catheter and cannula specifically designed for quick, easy and safe cholangiography.     

Laparoscopic cholecystectomy: a community experience.

Minimally invasive surgery appears to be gaining popularity, and removal of the gallbladder by laparoscopic methods is one such procedure for which there is recent enthusiasm. The concerns about safety, morbidity, and mortality in contrast to standard cholecystectomy are being evaluated. To address these concerns we reviewed the first 230 laparoscopic cholecystectomies done by one surgical group from October 1990 to September 1991. There were 161 women and 69 men with an average age of 50 years. The average length of stay was 2.1 days, most patients being discharged in 24 hours. Complications occurred in 14 patients (6%). The one death was unrelated to the gallbladder surgery. Operative cholangiograms were done as frequently as possible. It appears that laparoscopic cholecystectomy can be done safely and with a shorter hospital stay. Complications are similar to those seen with standard cholecystectomy.     

腹腔镜手术治疗合并肝硬变结石性胆囊炎

目的 总结腹腔镜手术治疗合并肝硬变结石性胆囊炎的体会。方法 45例结石性胆囊炎均合并有不同程度肝硬变，其中41例腹腔镜下行胆囊切除，2例胆囊切除加胆总管切开胆道镜探查T管引流术，2例开腹行胆囊切除加胆总管切开取石T管引流术。结果 45例均治愈。手术时间平均32分钟，平均住院5天。结论 腹腔镜胆囊切除术创伤小、痛苦少、恢复快，几乎不出血，特别适应于合并肝硬变的结石性胆囊炎腹腔镜手术治疗。     

老年人腹腔镜胆囊切除术治疗体会

目的探讨老年人腹腔胆囊切除术(LC)的麻醉及手术方法。方法在全麻和CO2气腹下，老年人106例LC术，中转开腹6例，3例术中经胆管造影。结果全部患者完成麻醉及手术，无严重手术并发症及死亡病例。结论老年人多伴有其他慢性器官疾病，术前应严格选择手术适应证，充分准备，术中加强监测及管理，术中相对放宽中转开腹指征，是预防和减少并发症的关键。     

Laparoscopic cholecystectomy: early Mayo Clinic experience.

Prospective data and follow-up information were collected on the initial 200 patients who underwent laparoscopic cholecystectomy at the Mayo Clinic. The operation was completed laparoscopically in all but five patients, who required conversion to laparotomy because of dense scarring or stones in the common bile duct. The median surgical time was 85 minutes. The major postoperative complications were retained stones in the common bile duct (in seven patients), intraperitoneal hemorrhage that necessitated transfusion (in two patients), and intra-abdominal abscess and pulmonary infection (in one patient each). The median hospital stay was 1 day (range, 0 to 8 days), and the median times to full activity and normal employment were 8 days and 12 days, respectively. Laparoscopic cholecystectomy is associated with a low frequency of complications in most patients with symptomatic gallstones and allows a rapid return to normal activity. Currently, laparoscopic cholecystectomy is the treatment of choice for most patients with symptomatic cholelithiasis.     

Case report: Laparoscopic cholecystectomy and cystic fibrosis

Summary

We report two cystic fibrosis patients with symptomatic cholelithiasis who were successfully treated by laparoscopic cholecystectomy. The procedure is safe, but it is essential that careful attention is paid to pulmonary care before and after surgery.     

腹腔镜胆囊切除术治疗急性胆囊炎621例

目的 探讨急性胆囊炎腹腔镜手术(LC)的处理方法。方法 对该院1992年9月～2003年2月621例急性胆裳炎LC术进行分析总结。结果 该组621例LC成功610例(98．23％)，中转开腹9例(1．45％)，再次手术3例(0．48％)；肝外胆管损伤3例(0．48％)，误夹胆总管1例(0．16％)，胆漏10例(1．61％)，肝下积液2例(0．32％)。结论 正确处理calot三角，合理使用胆囊大部分切除术、生物蛋白胶和引流，可以提高急性胆囊炎LC的成功率．减少并发症的发生。     

上腹部手术后腹腔镜胆囊切除术28例报告

目的　探讨上腹部手术后腹腔镜胆囊切除 (LC)的可行性及其适应证。方法　对 2 8例有上腹部手术史行腹腔镜胆囊切除术的临床资料进行回顾性分析。结果　 2 8例中 2 4例成功完成LC ,4例中转开腹 ,无术中、术后并发症发生。结论　上腹部有手术病史的患者不是腹腔镜胆囊切除术的禁忌证 ,基本可达到常规LC的效果。