急性胆囊炎腹腔镜手术时机的选择

目的 :探讨腹腔镜治疗急性胆囊炎的最佳时机。方法 :14 1例急性胆囊炎患者。按照手术时患者的发病时间分为 2组 ,早期手术组 88例 ,起病 72h以内行腹腔镜胆囊切除术 (LC) ;晚期手术组 5 3例 ,起病72h后行LC。结果 :早期手术组 4例发生并发症 (4 5 5 % ) ,5例中转开腹 (5 6 8% )。晚期手术组 12例发生并发症 (2 2 6 4% ) ,9例中转开腹 (16 98% )。对比 2组并发症的发生率及术后恢复时间 ,早期手术组缩短了住院时间 ,节省了医疗费用。并且早期手术组无 1例发生严重并发症。结论 :急性胆囊炎一经诊断明确应立即行LC ,在炎症、粘连坏疽出现前行LC治疗急性胆囊炎是安全有效的     

急性胆囊炎腹腔镜手术时机的选择

目的探讨急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的手术时机。方法回顾分析2006年7月～2011年3月186例急性胆囊炎行LC的临床资料,根据病程分为3组：病程72 h内为组1（n=81）,病程72 h～1周为组2（n=67）,病程1～2周为组3（n=38）;比较3组中转率、手术时间、术中出血量等。采用四孔法,前后结合解剖Calot三角,顺逆结合切除胆囊,并遵循疑难复杂胆囊结石LC的其他基本原则。结果 LC成功158例,中转开腹28例,中转率15.1%（28/158）。无手术并发症,无死亡病例。组1中转开腹率6.2%（5/81）显著低于组3 36.8%（14/38）（χ2=18.133,P=0.000）,但与组2 13.4%（9/67）无统计学差异（χ2=2.257,P=0.133）;组2中转开腹率13.4%（9/67）显著低于组3 36.8%（14/38）（χ2=7.768,P=0.005）。组1手术时间（42.6±11.4）min显著短于组2（77.4±12.6）min（q=24.863,P〈0.05）和组3（113.9±12.1）min（q=42.784,P〈0.05）,组2手术时间显著短于组3（q=21.206,P〈0.05）。组1出血量中位数20 ml（5～45 ml）显著少于组2 55 ml（30～90 ml）（Z=-6.819,P=0.000）和组3 110 ml（60～145 ml）（Z=-8.367,P=0.000）,组2出血量显著少于组3（Z=-5.306,P=0.000）。组1住院时间（6.9±2.2）d显著短于组2（11.3±2.9）d（q=14.762,P〈0.05）和组3（18.4±2.6）d（q=32.403,P〈0.05）,组2住院时间较组3显著缩短（q=19.370,P〈0.05）。结论急性胆囊炎72 h以内行LC最佳,手术时间较短,出血量较少,住院时间缩短,中转开腹率较低。     

急性胆囊炎腹腔镜手术时机的选择

我院自1992年10月份以来,对627例急性胆囊炎患者施行了LC,包括:(1)早期手术:发病72小时以内;(2)限期手术:发病超过72小时,抗炎解痉治疗(1周左右),症状缓解,同一住院期内手术;(3)择期手术:保守治疗炎症消退6～8周后手术。随机抽样100份病例,现将三组的疗效进行比较,结果表明:发病在72小时内的急性胆囊炎行LC是理想的手术时机。     

腹腔镜手术治疗急性胆囊炎38例体会

目的:探讨腹腔镜在急性胆囊炎手术治疗中应用。方法:回顾分析急性胆囊炎行腹腔镜手术的临床资料。结果:38例均行腹腔镜治疗。3例中转开腹,无1例严重并发症发生。结论:腹腔镜在急性胆囊炎手术中列为禁忌症,随着腹腔镜胆囊手术的经验积累和操作技术提高,现已成为一种腹腔镜手术的适应症。     

腹腔镜急性胆囊炎手术的时机与技巧

目的：探讨腹腔镜急性胆囊炎手术的时机与技巧。方法：对180例急性胆囊炎患者行腹腔镜常规法切除胆囊133例,胆囊壶腹部浆肌层内剥离法胆囊大部切除术32例,胆囊床部分黏膜组织残留的胆囊大部切除术22例,两种方法并用18例,中转开腹11例。结果：180例患者均治愈,术后轻度胆漏5例,无胆管损伤、术后出血等并发症。结论：选择合适的手术时机,根据术中不同情况选择合理的手术方法,可明显提高腹腔镜急性胆囊炎胆囊切除的手术成功率。     

胆囊结石伴急性胆囊炎的腹腔镜手术时机

目的 :探讨胆囊结石伴急性胆囊炎的腹腔镜手术时机。方法 :回顾分析 12 2例患者的临床资料。结果 :115例顺利完成腹腔镜胆囊切除术 (LC) ,7例中转开腹。全组并发胆漏 1例 ,粘连性肠梗阻 1例。结论 :只要掌握正确的手术时机 ,及时中转开腹 ,急性胆囊炎行LC是安全可行的。     

急性胆囊炎腹腔镜手术治疗体会

目的 探讨基层医院急性胆囊炎腹腔镜手术的安全性. 方法 回顾分析328例急性胆囊炎行LC手术临床资料. 结果 本组病例中转开腹11例,术后胆汁漏1例,行再次手术治愈. 结论 在基层医院选择好手术时机治疗急性胆囊炎安全、可靠.提高手术技巧,有利于降低中转开腹率和减少并发症.     

急性结石性胆囊炎腹腔镜手术时机探讨

目的探讨急性结石性胆囊炎行腹腔镜胆囊切除术(lparoscopic cholecystectomy,LC)的手术时机。方法回顾性分析我院2008年1月～2010年6月完成的397例LC患者的临床资料,按发病至手术时间间隔分为三组:A组165例,间隔时间<72 h;B组101例,间隔时间72 h～2周;C组131例,间隔时间>2周。比较三组平均手术时间、术中出血、中转开腹率、住院时间及住院费用。结果 397例手术中,中转开腹9例(2.3%),余均顺利完成LC,无死亡病例,术后病理均证实为急性结石性胆囊炎或慢性结石性胆囊炎急性发作。A组发生胆瘘3例,B组5例,均经抗感染等内科治疗并充分引流后治愈。无肠管损伤、腹腔感染等并发症。三组比较:A组手术时间短于B、C组(P<0.05),而B、C组间无统计学差异(P>0.05);B组出血量最大,C组最少,三组间有显著性差异(P<0.05);C组住院时间长于A、B组(P<0.05),A、B组间无统计学差异(P>0.05);B组并发症发生率高于A、C组(P<0.05),A、C组间无统计学差异;C组住院费用高于A、B组;三组间中转开腹率无统计学差异(P>0.05)。结论对于急性结石性胆囊炎,无论发病时间是否在72 h内,尽早行LC是安全可行的。     

急性胆囊炎腹腔镜手术146例报告

目的：探讨急性胆囊炎行腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）的可行性。方法：回顾性分析2000年2月～2005年2月146例急性胆囊炎腹腔镜手术切除的临床资料。结果：LC 130例，其中1例出现胆漏，1例腹腔残余结石，2例剑突下切13感染。中转开腹手术16例：结石嵌顿于胆囊管近端5例，胆囊及三角区炎症瘢痕粘连3例，胆囊动脉损伤3例，结石散落腹腔2例，胆囊与周围组织粘连严重2例，术中诊断胆囊癌1例。无死亡和肝外胆道损伤等并发症发生。结论：随着腹腔镜技术的日益成熟和手术经验积累，急性胆囊炎行LC是安全可行的。     

腹腔镜胆囊切除术治疗急性胆囊炎

目的 评价腹腔镜胆切除术（ＬＣ）治疗急性胆囊炎的手术指证,手术时机和手术经验。方法 对１９９３年４月～２０００年３月ＬＣ治疗急性胆囊炎４２例的临床资料进行回顾性分析。结果 术前发病时间〉７２小时者（９例）与〈７２小时者（３３例）的比较,后者行ＬＣ的平均手术时间及术后平均住院日均较短,中转开工发症率及平均住院费用亦较低,坏疽性胆囊炎组的中转开腹率明显高于非坏疽性胆囊炎组（Ｐ〈０．０５）,结论 急性胆     

急性胆囊炎腹腔镜胆囊切除术最佳手时机的选择

目的 探讨急性胆囊炎行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的手术时机.方法 回顾性分析我院2005年1月～2013年1月间,402例急性胆囊炎患者行腹腔镜胆囊切除术的病例资料;按发病到施行手术时间分为4组：72h内为A组（262例）,72h ～ 96h为B组（28例）,96h ～1周为C组（72例）,1周～2周为D组（40例）;通过比较4组间手术时间、出血量、术后住院时间、总住院时间、中转率和并发症发生率的差异,分析最佳手术时机.统计学采用单因素方差分析、LSD-t检验分析、Pearson Chi-Square检验或连续校正或Fisher确切概率.结果 成功施行LC340例,中转开腹62例;发生并发症20例.A、B、C、D组手术时间分别为（40.2±10.3）、（44.1 ±11.7）、（75.4±12.4）、（112±11.9） min,A、B组无统计学差异（P=0.331）,与C、D组有统计学差异（P=0.000）;出血量分别为（21.8 ±10.4）、（22.7±10.8）、（55.6±13.2）、（108.9±21.5）ml,A、B组无统计学差异（P=0.423）,与C、D组有统计学差异（P=0.000）;术后住院时间分别为（4.1±1.3）、（4.4±1.6）、（4.8±2.1）、（4.8±2.3）d,无统计学差异（P=0.873）;总住院时间分别为（7.1±1.4）、（7.5±1.9）、（11.2±1.9）、（16.7 ±2.1）d,A、B组无统计学差异（P =0.416）,与C、D组有统计学差异（P=0.000）;中转率分别为15.3％、17.9％、15.3％、15.0％,无统计学差异（P=0.987）;并发症发生率3.1％、7.1％、6.9％、12.5％,无统计学差异（P=0.261）.结论 急性胆囊炎发病96h内施行LC为最佳时机,手术时间及总住院时间较短,出血量较少.     

腹腔镜胆囊切除术治疗急性胆囊炎的比较分析

目的探讨胆囊炎急性发作时,实施腹腔镜胆囊切除术治疗的时间早晚对手术特点、手术技巧及手术结果的影响。方法对最近1年中我院54例急性胆囊炎腹腔镜胆囊切除术的过程、结果进行回顾性对照分析。结果54例中急性发作后48 h内40例行急诊腹腔镜胆囊切除术,手术时间短,无转开腹者;48 h后者手术时间长,3例转开腹,中转率为21.43%（3/14）。结论急性胆囊炎急诊施行腹腔镜胆囊切除术是有益的和必要的。     

老年患者急性胆囊炎行腹腔镜胆囊切除术与开腹式胆囊切除术的疗效比较

【摘要】〓目的〓比较腹腔镜胆囊切除术(LC)与开腹式胆囊切除术(OC)治疗老年患者急性胆囊炎的安全性和有效性。方法〓选择从2007年1月至2012年12月收治的年龄超过70岁急性胆囊炎患者76例,分别采用LC(34例)与OC(42例)治疗。观察两组的手术时间、术中失血、术后住院时间和术后并发症。结果〓两组患者手术均顺利完成胆囊切除术,且LC组无中转开腹的病例。LC组的手术时间为95.2±19.7 min,OC组的手术时间为86.8±21.2 min,两者差异无统计学意义;LC组术中失血>500 mL的有2例(5.9%),OC组术中失血>500 mL的有8例(19.0%)(P<0.05);LC组的术后住院时间明显少于OC组(P<0.01)。总共有24例患者在术后出现了并发症(31.6%),其中LC组的术后并发症明显少于OC组(P<0.05)。结论〓急性胆囊炎老年患者行腹腔镜胆囊切除术治疗能缩短术后住院时间和减少术后并发症发生率。     

胆囊颈部结石嵌顿急性胆囊炎的腹腔镜手术技巧探讨

目的 探索一种主要用普通吸引器协助分离暴露胆囊三角的操作手法在伴胆囊颈部结石嵌顿急性胆囊炎切除术中的有效性.方法 2008年1月至2011年2月行腹腔镜胆囊切除治疗胆囊颈部结石嵌顿的急性胆囊炎病人68例,女性38例,男性30例,其中有黄疸者(A组)26例,无黄疸者(B组)42例,两组均经MRCP检查排除胆总管结石.采用微创三孔术式,不用超声刀.术中主要通过吸引器的钝性剥、推及吸引,暴露出胆囊三角.胆囊管及胆囊血管用可吸收缝线结扎.结果 所有病例均成功经腹腔镜完成全胆囊切除术,无中转开腹.A组平均手术时间为(59.7±13.4) min,显著长于B组的(30.1±10.7)min,P＜0.01;术中出血量A组为(45.8±16.7) ml,显著多于B组的(20.4±13.5) ml,P＜0.01;A组引流管放置数显著高于B组;A组住院时间显著长于B组.除A组和B组各出现1例术后脐疝外,所有病例均无术后出血、胆漏、胆管损伤、腹腔感染、脐部切口感染及死亡等并发症.结论 在熟练掌握腹腔镜手术技巧及经验积累的基础上,采用吸引器等普通腹腔镜器械可以完成结石嵌顿的重症炎性胆囊切除术,避免手术中转或次全胆囊切除;可吸收缝线可避免金属夹引起的并发症和减少手术成本.     

A comparison of laparoscopic and open treatment of acute cholecystitis

Summary A retrospective review of 200 patients with acute cholecystitis, half of whom underwent open cholecystectomy and half of whom underwent laparoscopic cholecystectomy, was performed. The two groups were compared for demographic characteristics, operative course, cost of intervention, and surgical outcome. Laparoscopic cholecystectomy for acute cholecystitis was accomplished with an acceptable morbidity and provided an earlier release from the hospital and return to normal activities with a significant economic savings as compared to the traditional open approach.     

高龄老人急性结石性胆囊炎腹腔镜手术治疗经验

目的探讨高龄老人急性结石性胆囊炎(acute calculous cholecystitis,ACC)的手术指征、时机和技巧,以期提高其腹腔镜手术治疗效果。方法收集首都医科大学北京电力医院普外科2013年7月至2016年11月收治的43例高龄老人(≥80岁)ACC病人的临床资料,平均年龄为(83.5±2.7)岁,根据其是否具有手术指征,分为手术组和非手术组,对其并存病、实验室检查、手术时机(术前发病时间、体温、血白细胞计数及中性粒细胞比例、高敏C反应蛋白)、手术效果(手术时间、术中出血量、术后住院天数)、术后并发症和治疗效果进行分析。结果 43例高龄老人ACC病人手术组17例,其中腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)13例(最大年龄88岁,成功率100%),开腹胆囊切除术(open cholecystectomy,OC)4例,非手术组26例。手术组较非手术组疗效显著提高(P=0.003),LC组治愈率(92.3%)显著高于OC组(75.0%)。手术时机对手术效果无显著影响(P0.05),但对术后并发症有一定影响。结论高龄老人ACC病人LC是安全可行的,关键是掌握手术指征和时机、熟练掌握腹腔镜手术技巧,同时加强围手术期治疗,以期进一步提高其治疗效果和安全性。     

Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions

Background  Conversion rate to open surgery is higher for patients with acute cholecystitis than in those without acute cholecystitis. We attempted to develop a laparoscopic subtotal cholecystectomy to decrease this conversion rate. Methods  From 2000 to 2005, laparoscopic cholecystectomy for acute cholecystitis was performed in 60 patients (22 women, 38 men). Patients were divided into two groups: group A (2000 to 2002, n = 22) and group B (2003 to 2005, n = 38). When significant difficulty was encountered dissecting the gallbladder from its bed, we incised the gallbladder wall leaving the posterior wall and cauterizing the remnant mucosa (subtotal cholecystectomy, SC-1). When dissection of the gall bladder neck and triangle of Calot was difficult, the neck of the gallbladder was sutured despite clipping (SC-2). Results  Mean duration from onset of symptoms to operation was 55.3 ± 52.0 days. SC-1 was performed in 8 patients in group A and 18 patients in group B. SC-2 was performed in three patients in Group B. Conversion rate was 18.1% (4/22) in group A and 0% (0/38) in group B, compared to 0.4% (1/221) for patients without acute cholecystitis. No complications were associated with ablated gallbladder mucosa. Conclusion  Laparoscopic subtotal cholecystectomy offers safe and effective treatment for acute cholecystitis. The conversion rate in group B is decreased by avoiding hazardous dissection of the cystic duct.     

Early minilaparoscopic cholecystectomy in patients with acute cholecystitis

BACKGROUND: Recently, techniques using fine-caliber instruments (2 or 3 mm in diameter) for laparoscopic cholecystectomy, called minilaparoscopic cholecystectomy (MLC), were reported to be superior to conventional LC (CLC, using 5 mm instruments) in postoperative course and cosmetic outcome. However, the use of MLC to date has been largely restricted to uncomplicated situations. Since CLC has been proved to be a safe and efficient technique for acute cholecystitis especially if conducted early, this study tests the feasibility and safety of MLC for acute cholecystitis. METHODS: Sixty-nine consecutive patients with acute cholecystitis were prospectively randomized to minilaparoscopic (n = 38) or conventional laparoscopic (n = 31) cholecystectomy, and the operations were conducted within 2 days of admission whenever possible. Despite different operative techniques, both groups of patients received identical preoperative preparation, evaluation and postoperative care. The two groups were compared for patient characteristics, results of laboratory tests, predictive score for LC difficulties, operative time, operative complications, hospitalization days and need for meperidine injection for wound pain. RESULTS: The conversion rate was 7.9% (3 of 38) for the MLC group and 6.5% (2 of 31) for the CLC group. Nine patients in the MLC group and 7 in the CLC group had concomitant choledocholithiasis and underwent endoscopic stone retrieval before operation. The age, sex, predictive score for LC difficulties, preoperative leukocyte count, length of hospital stay and requirement of intramuscular meperidine injections were similar for both groups of patients, while, the operative times were marginally longer in the MLC group (113.8 +/- 30.8 versus 98.2 +/- 33.2 minutes, P = 0.056). No major complications occurred in either group. CONCLUSIONS: The results of cholecystectomy for acute cholecystitis by MLC are as good as those of CLC if the operation is performed early, with obvious smaller incisions and minimal complications. MLC is a safe and effective procedure for patients with acute cholecystitis, and has an acceptable low conversion rate.     

Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis. However, the rate of conversion to open cholecystectomy remains higher when compared with patients with chronic cholecystitis. Preoperative clinical or laboratory parameters that could predict the need for conversion may assist the surgeon in preoperative or intraoperative decision making. This could have cost-saving implications. METHODS: A retrospective review of 46 patients undergoing laparoscopic cholecystectomy for acute cholecystitis was performed. Records were assessed for preoperative clinical, laboratory and radiographic parameters on admission. Temperature and laboratory parameters were also recorded prior to surgery after an initial period of hospitalization that included intravenous antibiotics. The effect of admission and preoperative parameters as well as the trend in these parameters prior to surgery upon the rate of conversion to open cholecystectomy was assessed. RESULTS: Ten patients (22%) required conversion to open cholecystectomy. Conversion was required more often in males (43%) when compared with females (4%) (p=0.003). Conversion rate was 30% in patients with increased wall thickness by ultrasound compared with 12% for patients without wall thickening (p=ns). No admission or preoperative laboratory values predicted conversion. The trend in the patient's temperature (p=0.0003) and serum LDH value (p=0.043) predicted the need for conversion to open surgery. CONCLUSIONS: Preoperative prediction of the need for open cholecystectomy remains elusive. Male patients and patients with rising temperature and LDH levels while on intravenous antibiotics require conversion at increased frequency. However, the benefits of laparoscopic cholecystectomy warrant an attempt at laparoscopic removal in most patients with acute cholecystitis.     

Acute cholecystitis and laparoscopic cholecystectomy.

OBJECTIVE: To determine whether laparoscopic cholecystectomy (LC) should be the procedure of choice in treating acute cholecystitis. METHOD: A prospective study was conducted over a 4 1/2-year period. There were 187 patients with acute cholecystitis out of 1020 patients with gallbladder disease who required cholecystectomy. These patients were divided into three groups based on the time interval between the onset of pain and the time patients sought medical attention: Group 1, < 3 days; Group 2, 3 to 7 days; Group 3, > 7 days. All the patients underwent LC after a comprehensive preoperative workup. The parameters analyzed included operating time, hospital stay, and conversion rate. The comparison was made among the various groups and with those who had elective LC. RESULTS: One hundred twenty patients (64.17%) presented for treatment within 3 to 7 days of the onset of an attack. Empyema of the gallbladder was seen in 106 (56.68%) patients and phlegmon of the gallbladder in 42 (22.46%) patients. Group 3 patients had an operative time of 56.2 min as opposed to 18.5 min in Group 1 and 17.5 min in the elective LC group. The conversion rate in Group 3 was 19.5% versus 3.8% in Group 1 and 3.48% in the elective LC group. The complication rate was 7.3% in Group 3, 3.8% in Group 1, and 3.7% in the elective LC group. CONCLUSION: Acute cholecystitis is better managed by laparoscopic cholecystectomy, except in the patients presenting with a gallbladder phlegmon later than 7 days after the onset of the attack.