Imaging of complications of laparoscopic cholecystectomy

Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have aprimary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases), bowel perforation (two cases), abdominal abscess (two cases), intraperitoneal gallstones (2), and failure to diagnose malignant bile duct obstruction (one case). Twenty-two patients required reoperation, and one patient with bowel perforation died. Eleven of 15 bile duct injuries were imaged prior to hepaticojejunostomy. Nine of 11 were proximal bile duct injuries within 2 cm of the junction of the right and left bile ducts. Endoscopic retrograde cholangiography (ERC) identified the distal extent of injuries, but transhepatic cholangiography (THC) was necessary to fully evaluate the proximal extent of the bile duct abnormalities. ERC was used for diagnosis and treatment of the seven patients with choledocholithiasis. Abdominal films showed intraperitoneal gas in one patient with bowel perforation, intraperitoneal stones in a second patient, and intraabdominal abscess in one of two patients in whom abdominal films were performed. Computed tomography (CT), done in three patients with bowel perforation or abscess, showed the one duodenal perforation, and the two abscesses. CT also showed bilomas, intraperitoneal gallstones, and unsuspected malignancy. Imaging studies detected and defined complications after laparoscopic cholecystectomy in all cases.     

针对性护理对腹腔镜胆囊切除患者术后疼痛与并发症的影响

目的探讨针对性护理对腹腔镜胆囊切除术(LC)患者术后疼痛与并发症的影响效果。方法选择LC手术患者110例,按随机数字表法分为对照组与研究组,各55例。对照组采用常规护理措施,研究组在此基础上采用针对性护理干预改善术后疼痛症状与并发症情况。采用视觉模拟评分法(VAS)比较2组患者术后1 d、2 d、3 d时的疼痛情况,记录并比较2组术后并发症情况。结果研究组术后2 d、3 d时的VAS评分低于对照组(P0.05);2组术后1 d时的VAS评分差异无统计学意义(P0.05)。研究组术后并发症发生率为5.45%,低于对照组的18.18%(P0.05)。结论针对性护理应用于LC手术患者中具有显著效果,可有效缓解疼痛症状,降低并发症发生率,值得在临床推广。     

Radiology of cholecystectomy complications

Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed.     

开腹胆囊切除术372例护理体会

目的探讨开腹胆囊切除术后护理及并发症的防范措施。方法对372例开腹胆囊切除术患者术前心理护理、胃肠道准备,术后并发症的有效预防进行回顾性分析。结果372例均痊愈出院,无医源性胆道损伤、出血、胆漏等并发症发生。结论准确把握开腹胆囊切除术的适应证、充分做好术前准备,术后精心护理是手术成功的重要保证。     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

Delayed peritoneal and retroperitoneal abcesses caused by spilled gallstones: a complication following laparoscopic cholecystectomy

Many complications following laparoscopic cholecystectomy have been reported. We report a case of delayed peritoneal and retroperitoneal abcesses caused by spilled gallstones from a laparoscopic cholecystectomy performed 1 year earlier. This diagnosis was suggested only at sonography because the aggressive behavior of the lesions containing nonopaque gallstones suggested, by computed-tomography scan, peritoneal metastatic disease.     

Failed or difficult laparoscopic cholecystectomy: Can preoperative ultrasonography identify potential problems?

A prospective study was performed to assess the role of preoperative ultrasonography in predicting failed or difficult laparoscopic cholecystectomy. Fifty patients underwent detailed preoperative ultrasound examinations. The number and size of calculi, evidence of acute or chronic cholecystitis, gallbladder morphology, and the presence or absence of aberrant anatomy were documented. A comparison was made of the surgical outcome and the ultrasound findings in each patient. Six patients were converted to open cholecystectomy because of inflammatory changes in the gallbladder. The preoperative ultrasound studies in 5 of these patients demonstrated evidence of cholecystitis and cholelithiasis. Gallbladder wall thickening and contraction were also seen. Five gallbladder resections had intraoperative difficulties; preoperative ultrasonography demonstrated a thickened gallbladder wall in 2. Of 31 uneventful cases, 7 had evidence of gallbladder wall thickening and/or contraction. There were no ultrasound features that identified between the unsuccessful, difficult, or uneventful laparoscopic cholecystectomies. We conclude that detailed preoperative ultrasound evaluation of the gallbladder in patients destined for laparoscopic cholecystectomy is of little value in screening for difficult or unsuitable cases. © 1994 John Wiley & Sons, Inc.     

腹腔镜胆囊切除术治疗急性胆囊炎152例临床分析

目的总结急性胆囊炎行腹腔镜胆囊切除术（LC）的经验体会。方法2003年1月至2006年12月152例急性胆囊炎患者行腹腔镜胆囊切除术。CO2气体建立气腹,常规四孔法。结果140例患者成功完成腹腔镜胆囊切除术,12例患者因胆囊粘连致密易出血中转开腹;152例患者温氏孔放置引流管;148例随访5～48个月,平均30个月,无并发症发生,无死亡病例。结论严格掌握急性胆囊炎腹腔镜手术治疗的指征,规范腹腔镜操作技术,适时中转开腹,引流管的放置,是保证手术成功的关键。     

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。     

腹腔镜胆囊次全切除术在困难性胆囊切除中的应用

目的 探讨腹腔镜胆囊次全切除术(LSC)在困难性胆囊切除中的应用效果.方法 2006年6月至2009年2月,我院对40例解剖困难的胆囊结石患者行LSC.根据局部病理情况,采取3种LSC术式.其保留部分胆囊床(LSC Ⅰ式)9例,保留部分胆囊壶腹(LSC Ⅱ式)18例,保留部分胆囊床和壶腹(LSC Ⅲ式)13例.并在同期行腹腔镜胆囊切除术(LC)的384例病例中,按照性别相同,年龄、炎症类型、手术难度相近的原则,选择40例与LSC组一一配对,作为对照组.对比观察临床疗效.结果 LSC组和LC组均顺利在腹腔镜下完成手术,无中转开腹和胆道损伤发生.术中出血量LSC组[(73±26)ml]多于LC组[(41±12)ml],差异有统计学意义(t=4.183,P<0.05).手术时间LSC组[(77±15)min]与LC组[(81±14)min]比较,差异无统计学意义(t=1.538,P>0.05).住院天数LSC组[(6±6)d]与LC组[(7±5)d]比较,差异无统计学意义(t=0.616,P>0.05).LSC组的术者主要为腔镜经验5～10年(5～10年与10年以上的比例为32/8).LC组的术者主要为腔镜经验10年以上(5～10年与10年以上的比例为7/33),两者比较,差异有统计学意叉(χ~2=34.690,P<0.05).LSC组中2例(5.0%),LC组中3例(7.5%)术后出现胆漏(χ~2=0.231.P>0.05),均经保守治疗治愈.所有患者均病愈出院,术后随访无胆道狭窄、梗阻和残留小胆囊等并发症.结论 胆囊解剖困难时,LSC是一个安全、有效的选择,可避免传统的中转开腹手术.     

初期开展腹腔镜胆囊切除术258例无并发症发生的体会

目的总结早期开展腹腔镜胆囊切除术（LC）的疗效,以及如何避免并发症的发生。方法回顾性分析我院2006年5月至2008年4月施行的258例腹腔镜胆囊切除术的资料。结果 258例中256例成功完成腹腔镜胆囊切除术,2例因胆囊三角区解剖欠清晰而中转行开腹胆囊切除术,无手术并发症的发生。结论手术适应证的把握、精细的手术操作、对胆囊三角区解剖变异的熟识以及腹腔镜手术小组人员的相对固定是LC手术成功的关键。     

腹腔镜胆囊切除术无并发症1680例临床分析

目的探讨如何正确掌握手术适应证,合理运用手术技巧,预防腹腔镜胆囊切除术（LC）并发症的临床体会。方法回顾汉中职业技术学院附属医院外科开展1680例LC术患者的临床资料,就病例选择及手术技巧的运用与并发症预防进行总结探讨。结果本组1680例LC术,中转开腹6例,中转率4.2‰。全组病例无胆道损伤、术后出血及胆漏等并发症发生。结论 LC术的成功与否,取决于病例筛选及操作者技术熟练程度,熟悉胆道解剖及变异。只要重视手术过程的每一个环节,其并发症是完全可以避免的。     

Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature

BACKGROUNDGallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications. AIMTo compare outcomes including length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who undergo cholecystectomy during index admission as compared to those who undergo cholecystectomy thereafter. METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). RESULTSInitial search identified 163 reference articles, of which 45 were selected and reviewed. Eighteen studies (n = 2651) that met the inclusion criteria were included in this analysis. Median age of patients in the late group was 43.8 years while that in the early group was 43.6. Pooled analysis showed late laparoscopic cholecystectomy group was associated with an increased length of stay by 88.96 h (95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled risk difference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group. Pooled analysis showed no risk difference in intraoperative complications [risk difference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [risk difference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy [risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and late cholecystectomy groups. Pooled analysis showed the duration of surgery to be prolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy group as compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorter hospital stay, shorter duration of surgery, while decreasing the risk of biliary complications. Rate of intraoperative, post-operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy was performed early or late.     

Imaging of abdominal complications following cardiac surgery

Ten thousand seven hundred fifty-six patients underwent cardiac bypass surgery at the Mater Hospital national cardiac unit between September 1979 and April 1993. Of this group, 49 patients were identified who had developed postoperative gastrointestinal complications leading to 16 deaths. Twenty-five patients developed gastrointestinal hemorrhage, eight patients developed gallbladder disease, five patients developed phlegmonous pancreatitis, eight patients developed bowel perforations, and three patients developed intestinal pseudoobstruction. The particular radiological features that lead to diagnosis in each case are discussed and relevant literature is briefly reviewed.     

腹腔镜与开腹胆囊切除术对机体氧化应激的影响

【目的】探讨比较应用腹腔镜胆囊切除术（LC）和开腹胆囊切除术（OC）对患者机体氧化应激的影响。【方法】选择有胆囊切除术指征的80例患者分为LC组和0c组患者各40例,分别检测其术前术后静脉血中丙二醛（MDA）,超氧化物歧化酶（SOD）和血清总抗氧化物能力（T-AOC）3种氧化应激参数水平,并对检测结果进行统计学分析。【结果】检测数据经统计分析提示,LC组和0C组患者体内氧化应激状态存在异常,LC组24h左右氧化应激状态趋于正常,而OC组氧化应激状态持续存在。【结论】腹腔镜胆囊切除术存在导致氧化应激现象产生,但其恢复速度比开腹胆囊切除术快。     

三孔法腹腔镜胆囊切除与传统手术疗效比较

目的比较腹腔镜胆囊切除术（LC）与传统开腹胆囊切除术（OC）的疗效。方法对近3年我院的胆囊切除术的病例进行回顾性研究,根据手术发发将患者分为LC组（71例）和OC组（56例）,比较两组患者的切口大小、手术时间、术中出血量、住院天数、并发症的发生率等。结果两组手术均获得成功,无胆漏、无感染。LC组患者的手术时间、切口长度、术中出血、住院天数、并发症的发生率明显低于OC组（P〈0．05）。结论LC手术创伤小、术后恢复快。只要掌握好适应证,没有显示出比传统手术更多的并发症,是胆囊切除的首选方式。     

腹腔镜和开腹胆囊切除术对急性结石性胆囊炎患者胃肠功能和CRP的影响

目的探讨腹腔镜和开腹胆囊切除术治疗急性结石性胆囊炎后对胃肠功能和CRP的影响。方法将80例急性结石性胆囊炎行胆囊切除术患者,随机分为两组：腹腔镜组：40例行腹腔镜胆囊切除术;开腹组：行开腹胆囊切除术。对两组患者术后进行胃肠功能评价和CRP检测,进行对比分析。结果急性结石性胆囊炎术后胃肠功能评价：腹腔镜组40例患者,Ⅰ级8例占20．0％、Ⅱ级15例占37．5％、Ⅲ级17例占42．5％;开腹组40例患者,Ⅰ级5例占12．5％、Ⅱ级13例占32．5％、Ⅲ级22例占55．0％。急性结石性胆囊炎术后CRP检测评价：腹腔镜组40例患者,正常6例占15．0％、轻度升高11例占27．5％、中度升高16例占40．0％、重度升高7例占17．5％;开腹组40例患者,正常2例占5．0％、轻度升高13例占32．5％、中度升高14例占35．0％、重度升高11例占27．5％。结论腹腔镜手术时间明显低于开腹手术,避免了开腹后腹腔脏器的暴露,有利于手术后的胃肠功能快速恢复。腹腔镜手术创伤后较开腹手术机体免疫反应轻。