胆囊切除术三种术式的比较

目的 探讨小切口胆囊切除术的手术技巧和疗效. 方法 分析小切口胆囊切除术(MC组)420例,腹腔镜胆囊切除术(LC组)300例与传统开腹胆囊切除术(OC组)560例的手术时间(min)、术中出血量(ml)、恢复饮食时间(h)、住院天数、输液天数、腹腔引流例数、切口愈合等. 结果 手术时间、输液天数、恢复饮食时间、切口愈合情况,MC组、LC组优于OC组(P<0.05),而MC组与LC组差异无显著性意义(P>0.05);术中出血量MC组少于LC组和OC组(P<0.05);LC组中转OC组显著高于MC组中转OC组(P<0.05). 结论 掌握MC手术技巧,MC是一种简便、安全、低创的术式.     

小切口胆囊切除术

最早采用小的剖腹切口(minilaparotomy)行胆囊切除者大概是1982年的Dubois，而minicholecystectomy一词是1983年由Gaeo及Chambers所创用，近年又称为小切口胆囊切除术(minilaparotomy cholecystectomy，MC)。虽然，选择适当病例施行MC确具某些优点，但随着腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)的问世和掀起热潮，LC已成为胆囊切除的重要术式，以致MC未受到重视，迄今国外报道仅约2000例。国内报道例数就更少。为使同道们对MC有所了解，本文结合有限的文献资料，就MC的有关问题，简要介绍如下。     

比较腹腔镜胆囊切除术与小切口胆囊切除术的效果

目的比较小切口胆囊切除术(MC)与腹腔镜胆囊切除术(LC)治疗胆囊结石的效果。方法根据不同术式将接受手术的78例胆囊结石患者分为2组。MC组38例行MC,LC组40例实施LC。比较2组的治疗效果。结果 2组患者的手术时间、术中出血量和术后疼痛VAS评分、下床活动时间、肛门排气时间及住院时间比较,差异无统计学意义(P0.05)。但MC组的住院费用显著低于LC组,差异有统计学意义(P0.05)。结论 MC与LC治疗胆囊结石具有相同良好的疗效,但MC的治疗费用低廉。应在严格把握手术适应证的前提下,根据患者的病情、经济条件、医院设备和医生技术水平等因素综合分析,个体化选择术式。     

小切口胆囊切除术与腹腔镜胆囊切除术治疗胆囊良性疾病的临床效果

目的观察对比小切口胆囊切除术(MC)与腹腔镜胆囊切除术(LC)治疗胆囊良性疾病的临床效果,总结治疗经验及应用价值。方法将68例胆囊良性疾病患者随机分为观察组与对照组,各34例。观察组给予LC治疗,对照组使用MC治疗,观察2组治疗效果。结果观察组的整体有效率是88.24%,对照组是70.59%。2组比较差异有统计学意义(P<0.05)。结论 LC治疗胆囊良性疾病效果明显优于MC。微创、出血少、手术时间短、术后恢复快、安全可靠,值得临床推广。     

小切口胆囊切除术与腹腔镜胆囊切除术临床分析

目的 比较小切口胆囊切除术(MC)和腹腔镜胆囊切除术(LC)在住院费用、住院天数、并发症情况等方面的优缺点,探讨合适的手术方式. 方法 回顾性总结2001年7月至2004年12月的312例MC手术和121例LC手术的临床资料,比较其住院费用、住院天数、并发症情况. 结果 MC手术住院费用少于LC手术,但住院天数明显高于LC手术,两者在并发症方面差异不大. 结论 MC手术易于实施,器械等方面要求不高,住院费用也明显低于LC手术,适合基层医院开展.     

小切口胆囊切除术

小切口胆囊切除术上海市金山县中心医院外科（２０１５００）沈忠杰，金庆丰随着腹腔镜胆囊切除术的广泛开展，已对传统胆囊切除术提出了挑战。但由于这一新技术治疗胆囊疾病的效果尚存在一些问题，因此提出小切口胆囊切除术作为取代传统胆囊切除术的方式。我们自１９７６...     

胆囊切除术适应证的选择

胆囊切除术已有 10 0余年历史 ,至今 ,仍是外科临床上最常见的手术之一 ,并且目前接受该手术的患者有逐年增加的趋势。近年来 ,随着对胆囊疾病本质认识的深化及新的治疗手段和措施的出现 ,特别是腹腔镜技术的发展和普及 ,使得胆囊疾病的治疗进入到一个新的时代 ,在治疗观点和方法上 ,均有许多更新 ,以往的胆囊切除手术适应证也受到了很大冲击 ,因此 ,有必要再次探讨胆囊切除术的手术适应证。胆囊切除术是胆囊结石病人首选的治疗方法 ,外科临床上90 %以上的胆囊切除是用来治疗胆囊结石病人的。近年来 ,虽然出现一些对胆囊结石病的非手术疗法 …     

小切口胆囊切除术30例报道

腹腔镜胆囊切除术(LC)国内外虽已广泛采用，但也曾发生过严重并发症，因此，近年来又有人提倡小切口胆囊切除术(MC)。由于MC有简单、方便、用费低等优点，我院在过去1年多的时间内施行了MC30例，现报道如下。     

小切口胆囊切除术262例与腹腔镜胆囊切除术130例综合分析

目的：分析小切口手术及腹腔镜手术的利弊，探讨其使用及推广价值。方法：采用小切口与腹腔镜胆囊切除作前瞻性对比研究，观察对比了两组术前情况，术中切口、出血量、手术时间、腹腔引流次数、术后止痛剂次数、抗菌治疗天数、恢复饮食时间、下床活动时间、创口愈合情况、并发症发生、住院天数总费用等多种项目。结果：小切口胆囊切除术和腹腔镜胆囊切除术同具有创伤小、愈合快、恢复早的特点，但小切口手术更具有并发症少，直视灵活     

常规器械经脐单孔腹腔镜胆囊切除术的手术技巧

目的 探讨使用常规器械经脐单孔腹腔镜胆囊切除术的手术技巧及安全性.方法 总结分析我院2010年11月至2011年8月间为61例患者施行的使用常规器械经脐单孔腹腔镜胆囊切除术的经验,并分析手术中碰到的一些疑难问题和应对策略.结果 61例病人中,58例顺利完成单孔手术,3例改为2孔法腹腔镜胆囊切除,无中转开腹及手术并发症,...     

DEVELOPING CLINICAL INDICATORS FOR CHOLECYSTECTOMY

This study sets out to develop a set of clinical indicators for the frequently performed procedure, simple cholecystectomy. Four hundred consecutive cases of cholecystectomy were reviewed retrospectively and data were collected regarding the pre-operative condition of the patient as well as any postoperative complications. From this database a set of clinical indicators for simple cholecystectomy are recommended: wound infection rate 4.5%, re-operation or performance of another therapeutic procedure 3.5%. length of stay 7 days, and mortality < 0.025%. These threshold figures are to serve only as a ‘flag’ to possible problems.     

LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS

Sixty-eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty-two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC. One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC. Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be performed.     

OPEN CHOLECYSTECTOMY: A CONTROL GROUP FOR COMPARISON WITH LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy is rapidly becoming accepted as the best method for the treatment of symptomatic cholelithiasis. Randomized clinical trials comparing laparoscopic cholecystectomy with open cholecystectomy are unlikely to be performed. In order to compare these two operations, surgeons need an historical control group of patients who have undergone a conventional open cholecystectomy. The aim of this study was to document a control group of patients having an open cholecystectomy and compare them with patients having a laparoscopic cholecystectomy. This was achieved by a retrospective study of all patients who had an open cholecystectomy from January 1985 to December 1989. Four hundred and fifty-seven patients, 345 women and 112 men, had a cholecystectomy. Exploration of the common bile duct (ECBD) was performed in 59 (12.5%) cases. The mean operative duration was 73 min for cholecystectomy and 118 min for cholecystectomy and ECBD. The shortest mean postoperative stay was for an elective cholecystectomy (5.3 days) and the longest mean postoperative stay was for urgent admissions requiring ECBD (12.0 days). Operative dissection was difficult in 14.1% of elective cases and 51.8% of urgent cases. Ninety-seven (19.5%) patients had an additional procedure, unrelated to cholelithiasis, at the same operation; 44 did not require laparotomy, 31 had interval appendicectomies, and 22 other cases required laparotomy in order to perform the additional procedure. All but one patient required postoperative narcotic analgesia. The mean duration of narcotic analgesia was 2.3 days. The complication rate was 35.2% for cholecystectomy and 62.5% for ECBD. If pulmonary atelectasis is excluded as a complication, these complication rates fell to 6.8% and 20.1%, respectively. There was one right hepatic duct injury and no postoperative deaths. Comparison of these results with the published results for laparoscopic cholecystectomy revealed that although open cholecystectomy takes less time to perform, it is associated with a longer postoperative stay, greater narcotic analgesic requirements and more respiratory complications.     

COMPUTER-BASED SURGICAL AUDIT PROGRAMS: A REVIEW OF THREE CURRENT OPTIONS

Background : In order to find the most useful computerized auditing system for the needs of the QE II Hospital surgical department three surgical auditing software programs were assessed. Methods : The Otago University Surgical Auditing Program, the Australian Surgical Auditing Program, and RACS-Audit were trialled for a period of 1 month each. The software programs were evaluated to find the time requirements for data entry, the level of surgical knowledge needed for effective audit information entry, and the perceived usefulness of the generated reports. Results : It was found that the Otago University program best suited the needs of the department. This system was designed for use in a hospital environment with multiple users. The method of data collection was simple and rapid. Entry of data into the program was logical, well structured and able to be performed by both junior medical staff and clerical staff. Reports generated by this system included information in an appropriate format for the departments' morbidity and mortality meetings. Conclusion : Personal computers are an ideal tool for the undertaking of surgical audit. Software programs are designed for different uses and should be critically assessed to ensure that the method of data entry, the time involved, and the reports generated enable an efficient and effective audit to be carried out.     

腹腔镜治疗急性结石性胆囊炎的体会

目的 探讨腹腔镜治疗急性结石性胆囊炎的手术指征、手术时机和手术技巧.方法 对265例急性结石性胆囊炎施行腹腔镜胆囊切除术.结果 239例成功,26例中转.结论 腹腔镜治疗急性结石性胆囊炎是安全可靠的手术方式.     

胆囊结石合并肝硬化的腹腔镜治疗分析

目的探讨肝硬化患者腹腔镜胆囊切除术的可行性、安全性及手术技术特点。方法回顾分析我院自1991年3月至2007年3月间,240例Child A、B级肝硬化患者腹腔镜胆囊切除术的临床资料。结果LC成功224例,中转开腹16例。中转原因:结石嵌顿,Calot三角粘连10例;术中出血,镜下止血困难4例;术中发现胆道变异2例。LC手术时间40.3±12.5min,术中出血60.8±19.5 ml,术中无损伤;术后出血2例,肺部感染2例,泌尿系感染2例。无肝功能衰竭等严重并发症,均治愈出院。术后住院日5.2±2.0 d。结论对于Child A、B级肝硬化患者,腹腔镜胆囊切除术是一种安全可行的微创手术。     

胆囊炎症期的腹腔镜胆囊切除术

胆囊炎症或行腹腔镜胆囊切除术（LC）426例，其中急诊LC59冽，经抗炎解痉治疗10～15天择期LC215例，非急诊入院，术中发现明显炎性改变15例。临床病理类型：胆囊单纯充血、水肿208例，其中转剖腹手术11例；胆囊管梗阻、胆囊肿大、积液142例，中转剖腹手术14例；胆囊坏疽和积脓76例，中转剖仅手术20例。426例LC中成功377例，中转剖腹45例问0．6％），LC术后严重并发症（需再次手术者）4例（0．9％）。作者认为胆囊炎症期行LC是安全可行的，但LC不能完全取代剖腹胆囊切除术。