腹腔镜与开腹胆囊切除796例临床疗效对比分析

本文综合两院经腹腔镜胆囊切除术４００例与同期开腹胆囊切除术３９６例对比分析。结果：ＬＣ组手术时间、术后应用抗生素、输液、胃肠里面动恢复时间、术后病情恢复出院时间、并发症发生率等与ＯＣ组对比，均有非常显著性差异（Ｐ＜０．０１），认为ＬＣ是一种安全可行的胆囊切除方法，文中还讨论了两者疗效、并发症原因和处理。     

腹腔镜胆囊切除与小切口胆囊切除的比较

为比较腹腔镜胆囊切除（ＬＣ）与小切口胆囊切除（ＭＣ）的临床应用效果，自１９９３年９月～１９９５年７月，将同期收治的胆囊良性病变的病例分为ＬＣ组和ＭＣ组。ＬＣ组１１５例，治愈１０９例（９４．８％），中转ＭＣ５例，再次手术１例；ＭＣ组５７例，治愈５２例（９１．２％），延长切口５例。两组术后无出血、胆瘘、胆管损伤及肠穿孔等严重并发症。比较两组结果：在创伤疼痛、止痛剂、抗菌素用量、机体康复、住院时间及美容等方面，ＬＣ优于ＭＣ；术中出血量及手术时间两组无差异。提示：ＬＣ中转手术时应取ＭＣ；手术困难时，应掌握好ＬＣ及时中转ＭＣ及ＭＣ适当延长切口的指征。     

预防腹腔镜胆囊切除术并发症的体会

预防腹腔镜胆囊切除术并发症的体会杜国盛，萧荫祺，许红兵，邹一平，闫恒懦腹腔镜胆囊切除术（ＬＣ）可达到传统开腹切除胆囊的效果具有术后疼痛轻、住院时间短、恢复快等优点，已成为切除胆囊手术的重要方法．随着ＬＣ病例的增多，人们已认识到开膀胆囊切除术所发生的并...     

开腹胆囊切除术

１９６７￣１９９６年共施行胆囊切除手术６９７４例，其中开腹胆囊切除（ＯＣ）６６３１例，腹腔镜胆囊切除３４３例（ＬＣ），死亡１４例（０．２％），医源性胆管损伤１３例（０．１８％）。尽管多数有症状的胆囊结石病人，ＬＣ已成为首选治疗方法，然而ＯＣ仍不失为非常安全和效果可靠的疗法，在一些情况下，ＯＣ可能是唯一明智的选择，ＯＣ时预防胆管损伤的关键是仔细解剖和辨认胆囊管和胆总管交汇处。医源性胆管损伤多见于经验     

腹腔镜胆囊切除术11654例报告

１９９１￣１９９７年共施行腹腔镜胆囊切除术（ＬＣ）１１６５４例，其中发生严重并发症１１６例（１．０％），死亡６例（０．０５％）。大宗病例证明，ＬＣ与ＯＣ（开腹手术胆囊切除）比较总体并发症发生率和手术死亡率并无增加。目前，ＬＣ已成为多数有症状的胆囊结石首选治疗方式。本组资料总结了５所医院开展ＬＣ的情况，对ＬＣ的适应证、手术操作的要点、特殊情况下的处理以及ＬＣ值得注意的几个问题进行了讨论。作者认为严格     

腹腔镜胆囊切除术和开腹胆囊切除术的疗效分析

腹腔镜胆囊切除术（ＬＣ）３００例，并与开腹胆囊切除术２９６例进行对照分析。结果：ＬＣ手术时间４４．９６±１８．８５分钟；术后应用抗生素１．３５±０．６３天；输液１．６１±０．７７天；全部病例未用镇痛剂；胃肠蠕动时间７．５１±２．３９小时；术后住院时间３．７±０．８０天；术中术后共发生并发症１１例，并发症发生率为３．７％。开腹胆囊切除术组：手术时间１０１．７４±２８．６０分钟；术后应用抗生素６．５６±１．３４天；输液５．９２±１．５７天；术后有１５７例病人应用镇痛剂，占５３％；胃肠蠕动时间６２．２４±１８．１９小时；术后住院１１．２１±４．２４天；术中术后共发生并发症１６例，并发症发生率为５．４％。两组对各项均有非常显著性差异（Ｐ＜０．０１）。文中讨论了两者疗效、并发症发生原因及处理，以及ＬＣ与开腹胆囊切除术的关系。     

OC与LC术后的肺功能状况

ＯＣ与ＬＣ术后的肺功能状况季宝琴王克成李健宋录金近年来开展的腹腔镜行胆囊切除术（ＬＣ）与传统的剖腹行胆囊切除术（ＯＣ）相比，具有创伤小，应激反应轻［１］，对腹内脏器干扰少，恢复快和术后呼吸系统并发症少等优点，在临床得到推广，但其术后对肺功能的影响尚未...     

开腹胆囊切除术及腹腔镜钽囊切除术患者围手术期生理反应的比较研究

将需行胆囊切除的患者分为两组，每组各２１例，分别行腹腔镜胆囊切除术（ＩＣ）及开腹胆囊切除术（ＯＣ）。从手术前后的肺功能测定、动脉血气分析、血清皮质醇、红细胞沉降率（ＥＳＲ）、Ｃ反应蛋白以及术后尿流１７－ＯＨ皮质醇、尿素氮（ＢＵＮ）的结果分析，ＬＣ组术后肺功能优于ＯＣ组，动脉血气分析无显著性差别，ＬＣ组患者应激反应水平低于ＯＣ组，术后氮丢失较ＯＣ组少，且ＬＣ组术后肛门气分析无显著性差别，ＬＣ组患者激     

腹腔镜胆囊切除并发症原因分析及预防方法

腹腔镜胆囊切除并发症原因分析及预防方法何南飞，杨锡俊，陆文明，杨军，邓绍庆电视腹腔镜胆囊切除（简称ＬＣ）目前在国内呈迅速发展的趋势。我院从１９９２年３月至１９９３年１２月共开展ＬＣ手术３４６例。占我院同期胆囊切除的９５．５％（３４６／３６２）。其中发...     

胆囊切除后胆液中胆汁酸组成改变的观察

选择胆囊已切除病人２０例，在行胆道再次手术探查时用细针穿刺胆，总管采集胆液标本，检测胆液中十种结合型胆汁酸含量。同时选择胆囊结石２０例和无肝胆胰疾患的手术病人９例作对照。结果表明，牛磺能去氧胆酸（ＴＵＤＣＡ）的含量，胆囊已切除组显著高于对照组，牛磺胆酸（ＴＣＡ）和甘氨石胆酸（ＧＬＣＡ）、次级胆汁酸的含量，胆囊已切除组显著高于胆囊结石组和对照组。甘氨鹅去氧胆酸（ＧＣＤＣＡ）含量胆囊切除组显著低于胆囊结石组。作者对胆囊切除与结肠癌发病的关系以及胆汁酸成分组成的改变作了讨论，认为胆囊切除后肠道中次级胆汁酸浓度增高与大肠癌发病率升高有关。     

肝硬化患者行腹腔镜胆囊切除术的临床分析

目的:探讨肝硬化患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性、安全性及手术技术特点。方法:回顾分析120例Child A、B级肝硬化患者行LC的临床资料。结果:中转开腹8例。中转原因:结石嵌顿、Calot三角粘连5例;术中出血,镜下止血困难2例;术中发现胆道变异1例。LC平均手术时间(40.3±12.5)min,术中平均出血(60.8±19.5)ml,术中无损伤,术后出血、肺部感染、泌尿系感染各1例。无肝功能衰竭等严重并发症,均治愈出院,术后平均住院(5.2±2.0)d。结论:对于Child A、B级肝硬化患者,LC是一种安全可行的微创手术。     

腹腔镜胆囊切除术对机体免疫球蛋白、补体及CRP的影响

目的 :研究腹腔镜胆囊切除术 (LC)和开腹胆囊切除术 (OC)对机体免疫功能的影响。方法 :检测LC 2 0例和OC 18例患者入院次日、术后 2 4h和 4 8h的IgG、IgA、IgM和补体C3、C4 及C 反应蛋白质 (CRP)含量并进行对照研究。结果 :LC组免疫球蛋白及补体水平手术前后无变化 ,OC组术后血清IgG和C3低于术前水平 ,两组间差异无显著性 (P >0 0 5 ) ,但OC组术后下降幅度比LC组大 ,两组间差异有显著性 (P <0 0 5 )。两组术后CRP均明显升高 ,而OC组术后改变明显高于LC组 ,两组间差异有显著性 (P <0 0 1)。结论 :LC和OC术后早期免疫功能均在一定程度上被抑制 ,但LC组的免疫抑制程度较OC组轻 ,恢复快 ,表明LC对机体的创伤较小 ,是微创手术     

肝硬化并胆囊结石行腹腔镜手术与开腹胆囊切除术的疗效比较

目的比较腹腔镜胆囊切除术（LC）与剖腹胆囊切除术（OC）在合并肝硬化的胆囊结石症治疗中的效果。方法回顾性分析我院2001年1月-2007年6月收治的72例合并肝硬化的胆囊结石症手术病人的临床资料。其中,LC组38例,0t2组34例。观察两组病人的手术时间、术中出血量、手术并发症发生率和住院时间的资料,并进行统计学分析。结果LC组的手术时间、术中出血量、住院时间分别为（51．7±12．7）min、（98．6±25．5）ml、（6．2±2．9）d,OC组分别为（75．7±23．8）min、（134．6±36．6）ml、（9．2±3．7）d,两组比较均有显著性差异（P〈0．05）;手术并发症发生率LC组较OC组低（P〈0．05）。结论对Child分级为A级和B级合并肝硬化的胆囊结石病人采用LC治疗是相对安全的,并具有手术时间短、出血量少、手术并发症发生率低等优点。     

Laparoscopic cholecystectomy. A clinical and financial analysis of 280 operations.

Two hundred eighty patients underwent laparoscopic cholecystectomy (LC) and were compared with 304 patients who underwent traditional "open" cholecystectomy (OC). Laparoscopic cholecystectomy was performed electively in 72.5% of cases and urgently in 27.5% of cases. Conversion from LC to OC was required in 14 patients (5%), six of whom required common bile duct exploration. Common bile duct stones were managed with video-laparoscopic techniques in 11 patients, with percutaneous transhepatic laser lithotripsy in three patients, and with laparotomy in six patients. Hospital stay was significantly shorter and complications were significantly fewer for LC compared with OC. Hospital expenses for LC were significantly higher than for OC because of longer duration of operation and higher operating room expenses. Patients who underwent elective LC returned to work an average of 31 days earlier than patients who underwent OC (10 days vs 41 days). These data indicate that LC can be performed safely although at a higher cost than OC, and that patients as well as employers benefit from a short length of hospital stay.     

腹腔镜与开腹胆囊切除手术对患者生存质量的影响

目的：调查胆囊切除手术后患者生存质量的变化情况,比较开腹手术（OC）和腹腔镜手术（LC）对患者生存质量影响的差异。方法：采用消化病生存质量指数（GLQI指数）前瞻性地测定25例腹腔镜胆囊切除术及26例开腹胆囊切除术患者在术前以及术后2、5、10和16周的生存质量值。结果：LC组和OC组患者术前平均GLQI指数分别为112分和110分（P＞0．05）。LC组患者术后2周时,GLQI指数为110分,下降不明显（P＞0．05）,手术5周以后,GLQI指数和主观症状、躯体生理功能状态、心理情绪状态各方面均显著高于术前水平（P＜0．05）。OC组患者术后2周时GLQI指数为102分,降幅明显（P＜0．05）,同时,主观症状、躯体生理功能状态和心理情绪状态等各方面的分值均明显下降（P＜0．05）,术后5周时GLQI指数109分,恢复至术前水平（P＞0．05）,手术10周以后,GLQI指数和主观症状、躯体生理功能状态、社会活动状态各方面分值均明显超出术前水平（P＜0．05或P＜0．01）。手术后10周内LC组GLQI指数显著高于OC组（P＜0．05）。结论;腹腔镜胆囊切除手术较开腹手术更有利于患者术后恢复和提高生存质量。     

Laparoscopic cholecystectomy in transplant patients

Summary Acute cholecystitis is a serious condition in transplant patients and elective cholecystectomy is generally recommended when gallstones are found. We reviewed the results of laparoscopic cholecystectomy (LC) in 10 immunosuppressed transplant patients (6 heart, 4 kidney) and compared them to the results of open cholecystectomy performed in 26 transplant patients (14 heart, 11 kidney, 1 kidney/pancreas). The LC group had a 20% incidence of minor complication with no major complications and no deaths. The open-cholecystectomy group experienced 19% minor complications, 23% major complications, and 15% deaths. The average postoperative length of stay for the LC patients was 4.6 days (2 days for the 5 straightforward cases) as compared to 9.1 days after open cholecystectomy (4 days for the 13 straightforward open cases). Oral immunosuppression was stopped prior to operation but could be restarted within 29 hours after operation in the LC patients and 68 h in the open cases. The findings at LC were helpful in assessing whether acute cholecystitis and/or choledocholithiasis was the source of fever, liver-function abnormalities, or pancreatitis in these immunosuppressed transplant patients. We conclude that LC can be performed safely in transplant patients, but that in 10–20% of patients, the operation will be converted to an open procedure. The advantages of LC in these patients are a shorter hospitalization and less delay to resumption of preoperative oral immunotherapy than after open cholecystectomy.     

腹腔镜与开腹胆囊切除胃肠压力变化的临床研究

目的 :从胃肠道压力变化的角度探讨腹腔镜与开腹胆囊切除对胃肠运动功能的影响。方法 :腹腔镜胆囊切除 30例 (男 6例 ,女 2 4例 ,4 7± 4岁 ) ,开腹胆囊切除 30例 (男 9例 ,女 2 1例 ,4 7± 7岁 ) ,分别于手术前 1d行胃电图描记 ,记录术后 3、2 4、4 8、72h胃电图及监测胃窦、十二指肠和空肠压力 (移行性运动复合波 ,MMCⅢ )。结果 :(1)手术前腹腔镜和开腹胆囊切除患者胃电频率差异无显著性 (P >0 .0 5 ) ;(2 )腹腔镜胆囊切除组术后 3、2 4h正常波所占百分比低于术前 ,但差异无显著性 (P >0 .0 5 ) ,术后 4 8h恢复正常 ;(3)开腹胆囊切除组术后起 3h正常波所占百分比明显低于术前 ,差异有显著性 (P <0 .0 1) ,术后 2 4、4 8h正常波的百分比与术前差异无显著性 ,术后 72h恢复正常 ;(4) 2组患者术后胃窦、十二指肠及空肠压力低于健康人群 (P<0 .0 5 ) ;(5 ) 2组胃窦部收缩压力及收缩曲线下面积术后第 1、2、3d较术后 3h明显升高 (P <0 .0 5 ) ,且随时间延长有逐渐增大的趋势 ,腹腔镜组术后 72h恢复正常 ,十二指肠及空肠术后 3d内无明显变化 ;(6 ) 2组间胃电频率 ,胃窦部、十二指肠及空肠压力变化差异无显著性 (P >0 .0 5 ) ,但显示有差别。结论 :腹腔镜与开腹胆囊切除术均可引起胃电频率及胃肠压力变化 ,开     

Prospective study on patients outcome following laparoscopic vs. open cholecystectomy

AIMS OF THE STUDY: Differences in outcome between patients undergoing laparoscopic (LC) vs. open cholecystectomy (OC) should be examined under objective and subjective aspects. METHODS: We prospectively evaluated the postoperative course of 135 patients who underwent LC or OC in 1999. In the first step we examined the recover period with the help of the modified McPeek-Index. In the second phase during a 35 postoperative days-spanned analysis all patients noted there physical, emotional and social well-being in a circulating standard questionnaire, based on the modified Gastrointestinal Quality Life Index (GIQLI). RESULTS: Responses were obtained from 103 patients (76.3 %) undergoing 29 OC and 74 LC. 21.4 % of the patients aged 70 and older or had perioperative risks > II in ASA-Classification (LC 19.8 vs. OC 30.1 %). The (objective) McPeek-Outcome was similar in both groups, with no statistical advantage for LC (best score: 69 % LC vs. 62 % OC). The subjective assessment of the patients showed that patients having LC felt fully fit 10.2 days earlier than patients after OC (23.9 vs. 34.1 days). Patients in the LC-group returned to work after an average of 24.7 days, compared with 42.2 days following OC. The main finding of the postal questionnaire was a significantly earlier recruitment in physical, emotional and social status following LC in the group of aged > 70 and > ASA II-Score-patients, in contrast to control-OC-group. CONCLUSION: The study suggests an additional advantage in surgical outcome after LC, in comparison to OC. The laparoscopic approach is the preferable procedure to treat especially older and comorbide patients, when local or anesthesiological contraindications are absent.     

腹腔镜胆囊切除术对细胞因子、内皮素和C反应蛋白水平的影响

目的:探讨开腹与腹腔镜胆囊切除术(LC)2种方法对胆囊疾病患者血中细胞因子、内皮素和C反应蛋白的影响,比较两种方法对机体损伤的程度及安全性。方法:选择行剖腹胆囊切除术(OC)患者50例,LC患者50例,分别于术前和术后抽取静脉血检测IL-2、IL-6、NK细胞活性、CD4/CD8、内皮素、C反应蛋白含量并进行比较。结果:OC组IL-2和NK细胞活性术后较术前下降(P<0.05),IL-6术后较术前明显上升(P<0.01)。IL-6术后OC组较LC组上升(P<0.05)。OC组IL-2术后较LC组降低(P<0.05)。CD4/CD8未发现明显变化。OC组血中内皮素术后含量明显高于LC组患者(P<0.01),C反应蛋白于术后亦高于LC组。结论:研究表明LC损伤小,是一种安全可靠的手术方式。     

老年人腹腔镜胆囊切除的临床评价与风险防范

目的 :评价老年人腹腔镜胆囊切除术 (LC)的安全性及可行性 ,探讨防范风险的应对措施。方法 :比较、分析 6 0岁以上老年人LC组 (n =74 )、开腹胆囊切除 (OC)组 (n =36 )及中青年LC组 (n =2 82 )的临床资料。结果 :老年人LC及OC组并存病显著高于中青年LC组 (P <0 0 0 1 )。LC组患者术后恢复良好 ,未发生严重并发症 ;平均手术时间 ,平均术后住院天数及中转开腹率两组差异均无显著性 (P >0 0 5 ) ;而OC组平均手术用时、平均术后住院天数均显著延长 (P <0 0 0 1 ) ,且并发症多 (P <0 0 5 )。结论 :只要高度重视围手术期的处理 ,正确评估麻醉与手术的风险 ,把握手术时机及技巧 ,对老年患者施行LC不仅安全可行 ,而且更能凸现微创的优越性