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急性结石性胆囊炎腹腔镜手术252例 总被引:20,自引:0,他引:20
目的:探讨急性结石性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术操作要点.方法:回顾性分析本院1995-10/2005-10收治的252例胆囊结石并急性胆囊炎LC病例.结果:应用熟练的镜下操作技术,仔细解剖 Calot三角、近胆囊断离胆囊动脉、恰当处理术中出血、灵活应用电凝止血与钛夹止血相结合,顺利完成腹腔镜胆囊切除术244例,中转开腹胆囊切除术8例,系因合并胆囊癌、十二指肠球部巨大溃疡、Mirizzi综合征、胆囊壶腹部与胆总管粘连严重、胆囊十二指肠致密粘连及内瘘形成等原因而中转开腹,无术中大出血、肝外胆管损伤而中转开腹的病例.无术后胆漏、腹腔内出血等严重并发症发生.近期随访无胆管狭窄并发症发生.结论:急性胆囊炎行LC安全可行,关键是术者必须充分了解LC操作要点和熟练掌握操作技术. 相似文献
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《临床肝胆病杂志》2015,(10)
目的探讨腹腔镜下胆囊切除术(LC)中肝外胆管变异的辨别及治疗方法,以减少胆道损伤的发生。方法回顾性分析2012年1月-2014年1月在武汉市蔡甸区人民医院行LC且术中发现肝外胆管结构变异的60例患者相关临床资料,总结术中及术后情况。结果术中发现胆囊管变异32例,胆囊管汇入肝外胆管位置异常20例,胆囊管与肝总管共一侧壁再汇入胆总管2例,胆囊床迷走胆管2例以及副肝管4例。顺利完成LC患者51例,成功率85%;中转开腹9例,中转率15%。所有患者均顺利完成手术,有2例发生术后并发症,其中1例存在胆管残留结石,另1例LC术后1周发生胆汁渗漏,再次手术后恢复。所有患者均痊愈出院,未出现腹腔内出血、感染及肠道损伤等严重并发症。结论掌握肝外胆管结构变异,术中细致分离解剖胆囊三角区,辨别肝外胆管变异的种类,针对性地给予合适的操作方法是LC的关键,可明显降低胆道损伤的发生率。 相似文献
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腹腔镜胆囊切除术后28例漏胆的观察及护理 总被引:3,自引:0,他引:3
邱永梅 《世界华人消化杂志》2001,9(4):477-478
1 材料和方法我院1991-09/2000-10共行电视腹腔镜胆囊切除术8000例,发生漏胆28例,其中男11例,女17例,平均年龄(28~65)岁。胆囊结石27例。胆囊息肉1例。肝外胆管损伤9例;发生率是同期腹腔镜胆囊切除术的0.12%,较国内外文献报告均低。胆瘘19例,其中副肝管损伤3例,胆囊管残端瘘4例,迷走胆管瘘或胆囊床毛细胆管渗漏12例,24例术中放置引流管,9例24h引出胆汁性液体>500mL,经3d~8d引流观察无减少,再次手术;15例24h引出胆汁性液体<300mL,经7d~36d引流胆汁逐渐减少至消失拔管;2例未置腹腔引流管,分别于术后d3~d9出现腹胀、腹痛、发热,B超示腹腔大量积液剖腹手术;2例虽置有腹腔引流管,但术后5h~6h脱落,5d后证实腹腔内大量积液剖腹手术。 相似文献
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采用腹腔镜手术治疗合并糖尿病的肝脓肿12例,手术均成功。手术时间35~90(55±16)m in;术后疼痛较轻,患者均可耐受;术后住院时间为(14±6)d;4例并发胆囊结石者行肝脓肿引流术同时给予胆囊切除。认为腹腔镜手术治疗肝脓肿手术盲目性小,腹腔内污染机会较少;患者术后恢复快、疤痕小,住院时间短,费用低,术后并发症少;可同时治疗合并的胆囊结石和(或)胆管结石。 相似文献
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目的探讨腹腔镜肝左外叶切除治疗肝左外叶胆管结石的方法及疗效。方法回顾性分析我科2005年5月-2010年5月共12例患者行腹腔镜肝左外叶切除术治疗肝左外叶胆管结石的临床资料,其中2例并发胆囊结石,术中加行腹腔镜胆囊切除术。结果 12例均在腹腔镜下顺利完成手术,术中出血70 mL~370 mL,术后12例均出现一过性转氨酶升高,3例出现肝残面积液,无残留结石、大出血、胆瘘、腹腔脏器损伤等严重并发症发生。结论腹腔镜肝左外叶切除治疗左肝外叶胆管结石是安全可行的。 相似文献
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目的探讨内镜逆行胰胆管造影(ERCP)在腹腔镜胆囊切除术(LC)后胆管并发症诊治中的应用价值。方法对96例LC术后胆管并发症者行ERCP检查,并根据检查结果给予相应处理。结果本组ERCP显示,胆管残余结石70例,45例采用括约肌切开术(EST),25例采用乳头气囊扩张术(EPBD),结石排出67例;胆总管部分狭窄17例,行胆管扩张和内镜逆行胆管内引流术(ERBD),术后随访1a狭窄解除12例;胆总管完全横断5例,2例行ERBD,黄疸减退后均行外科胆管空肠Roux—en—Y吻合;胆瘘4例,3例经EST治疗后症状减轻,避免手术,1例症状无改善接受手术治疗。结论对Lc术后胆管并发症者行ERCP,有助于明确病因,并指导相应的治疗。 相似文献
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Castellón Pavón CJ Fernández Bermejo M Morales Artero S Del Amo Olea E 《Gastroenterologia y hepatologia》2004,27(10):568-572
Laparoscopic cholecystectomy is the treatment of choice in symptomatic cholelithiasis. Despite its many advantages over the conventional laparotomic approach, accidental perforation of the gallbladder with spilled stones and bile leakage is frequent during this procedure. Complications from missed gallstones are uncommon, although they can sometimes lead to severe consequences. Great effort must be made to achieve laparoscopic retrieval of all the gallstones missed into the peritoneal cavity and conversion to an open procedure should be used only in selected cases. We report a case of subhepatic abscess as a late complication of a missed gallstone during a previous laparoscopic cholecystectomy. 相似文献
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Duca S Bãlã O Al-Hajjar N Lancu C Puia IC Munteanu D Graur F 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2003,5(3):152-158
BackgroundEven though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed.Materials and methodsOver the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years.ResultsThe main operative incidents encountered were haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%).DiscussionMost of the postoperative incidents (except bile duct injuries) were solved by laparoscopic means. Among patients with postoperative complications 28.9% required revisional surgery. In 42.2% of cases minimally invasive procedures were used successfully: 15 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 22 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients. 相似文献
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Takeshi Urade Hidehiro Sawa Koichi Murata Yasuhiko Mii Yoshiteru Iwatani Ryoko Futai Shohei Abe Tsuyoshi Sanuki Yukiko Morinaga Daisuke Kuroda 《Clinical journal of gastroenterology》2018,11(5):433-436
Omental abscess due to a spilled gallstone is extremely rare after laparoscopic cholecystectomy. Herein, we report a 68-year-old man who presented with left upper abdominal pain after laparoscopic cholecystectomy for gangrenous cholecystitis. Seven months prior to admission, gallbladder perforation with spillage of pigment gallstones and bile occurred during laparoscopic cholecystectomy. The spilled gallstones were retrieved through vigorous peritoneal lavage. Abdominal computed tomography showed a 3?×?2.5 cm intra-abdominal heterogeneous mass, suspected to be an omental abscess, and ascites around the spleen. Exploratory laparoscopy revealed an inflammatory mass within the greater omentum. Laparoscopic partial omentectomy and abscess drainage were performed, and a small black pigment gallstone was unexpectedly found in the whitish abscess fluid. Abscess fluid culture results were positive for extended-spectrum β-lactamase-producing Escherichia coli and Streptococcus salivarius, which were previously detected in the gangrenous gallbladder abscess. The histopathological diagnosis was abscess in the greater omentum. Postoperative course was uneventful, and the patient was discharged 13 days later. In conclusion, we report a successful case of laparoscopic management of an omental abscess due to a spilled gallstone after LC. It is important to attempt to retrieve spilled gallstones during LC because they may occasionally result in serious complications. 相似文献
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Loffeld RJ 《The Netherlands journal of medicine》2006,64(10):364-366
Laparoscopic cholecystectomy has become the preferred surgical technique for symptomatic gallstone disease. The technique generally is safe. probably one of the most common intra-operative complications is gallbladder perforation with stones spreading into the peritoneal cavity. In this paper the sequelae of lost gallstones after laparoscopic cholecystectomy and the diagnostic problems facing the clinician are reviewed. Abscesses and fistula formation in the abdominal wall occur. A long delay can be present between the initial operation and the complications of the lost stones. Although rupture of the gallbladder is usually noticed during preparation and retrieval, the surgeon may not be aware of losing stones. due to the long delay, the occurrence of intra-abdominal abscesses and fistula is often not linked to the prior procedure. 相似文献
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Habib E Elhadad A 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2003,5(2):118-122
IntroductionSerious complications can ensue if a gallstone is dropped into the peritoneal cavity during laparoscopic cholecystectomy and not retrieved.Case outlineA 75-year-old-man was admitted with intestinal obstruction 8 years after laparoscopic cholecystectomy. Ultrasound scan and a contrast x-ray of the small bowel showed a gallstone within the small bowel lumen that CT scan had failed to identify. Laparotomy showed a Meckel''s diverticulum plus a 4×6-cm gallstone in the terminal ileum. The gallstone had penetrated into the Meckel''s diverticulum before migrating into the ileum and obstructing it.DiscussionGallstones lost during laparoscopic cholecystectomy can cause an intraperitoneal abscess. In addition, they can migrate through the anterior or posterior abdominal wall or the diaphragm and into the urinary tract or bronchus. The resulting abscess can obstruct the digestive tract or drain into the digestive tract to cause a communicating abscess. It can also drain through the abdominal wall and the digestive tract to cause an enterocutaneous fistula. Lastly, the stone can migrate into the intestine and cause gallstone ileus. Following laparoscopic cholecystectomy, patients with a lost gallstone may suffer from abdominal pain and fever within days or months. Thus, all dropped gallstones should be removed during laparoscopy. 相似文献
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The management of common bile duct (CBD) stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of last century, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) has become the mainstream treatment for CBD stones and gallstones in most medical centers around the world. However, in certain situations, ERCP cannot be feasible because of difficult cannulation and extraction. ERCP can also be associated with potential serious complications, in particular for complicated stones requiring repeated sessions and additional maneuvers. Since our first laparoscopic exploration of the CBD (LECBD) in 1995, we now adopt the routine practice of the laparoscopic approach in dealing with endoscopically irretrievable CBD stones. The aim of this article is to describe the technical details of this approach and to review the results from our series. 相似文献
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逆行胰胆管造影、乳头括约肌切开配合腹腔镜胆囊切除术治疗胆石症 总被引:6,自引:0,他引:6
为治疗伴有或可疑伴有胆总管结石的胆囊结石病人,在对胆囊结石病人行腹腔镜胆囊切除术(LC)时,对LC术前可疑伴有胆总管继发性结石的142例病人(术前组)和LC术后可疑胆总管残留结石的39例病人(术后组)选择性地行逆行性胰胆管造影(ERCP)检查和乳头括约肌切开术(EST)治疗。结果:术前组ERCP发现胆总管继发结石65例,EST清除结石60例,清除率91.5%;术后组ERCP发现胆总管残留结石6例,EST清除结石5例。结果提示ERCP、EST配合LC治疗伴有胆总管结石的胆囊结石病人是一种安全有效的好方法,明显减少了LC的并发症和胆总管结石开腹手术的比例。 相似文献
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Yadav RK Yadav VS Garg P Yadav SP Goel V 《The Indian journal of chest diseases & allied sciences》2002,44(2):133-135
Laparoscopic cholecystectomy is the treatment of choice for uncomplicated gallstone disease. Laparoscopic cholecystectomy may result in lost (spilled) gallstones. Such stones may precipitate various infective intra-abdominal complications. An unusual case of spilled gallstones eroding the diaphragm and eventually being expectorated out 12 months after laparoscopic cholecystectomy is reported. 相似文献
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Monica Acalovschi 《World journal of gastroenterology : WJG》2014,20(23):7277-7285
Gallstones occur in about one third of the patients having liver cirrhosis. Pigment gallstones are the most frequent type, while cholesterol stones represent about 15% of all stones in cirrhotics. Increased secretion of unconjugated bilirubin, increased hydrolysis of conjugated bilirubin in the bile, reduced secretion of bile acids and phospholipds in bile favor pigment lithogenesis in cirrhotics. Gallbladder hypomotility also contributes to lithogenesis. The most recent data regarding risk factors for gallstones are presented. Gallstone prevalence increases with age, with a ratio male/female higher than in the general population. Chronic alcoholism, viral C cirrhosis, and non-alcoholic fatty liver disease are the underlying liver diseases most often associated with gallstones. Gallstones are often asymptomatic, and discovered incidentally. If asymptomatic, expectant management is recommended, as for asymptomatic gallstones in the general population. However, a closer follow-up of these patients is necessary in order to earlier treat symptoms or complications. For symptomatic stones, laparoscopic cholecystectomy has become the therapy of choice. Child-Pugh class and MELD score are the best predictors of outcome after cholecystectomy. Patients with severe liver disease are at highest surgical risk, therefore gallstone complications should be treated using noninvasive or minimally invasive procedures, until stabilization of the patient condition. 相似文献