基层医院开展急性胆囊炎、胆囊结石行腹腔镜胆囊切除术的体会

目的 回顾总结基层医院开展急性胆囊炎、胆囊结石行腹腔镜胆囊切除术(LC)的经验体会。方法 手术采取四孔操作法。结果完成LC术351例，其中急性胆囊炎、胆囊结石29例，中转开腹2例。剑突下切口感染1例，住院时间平均8d(6-10d)。结论 只要经过严格规范化培训。聘请专家指导，开展初期从严掌握手术指征，采取正确的胆囊三角解剖技巧，适时中转开腹，合理放置引流，基层医院安全地开展急性胆囊炎、胆囊结石行腹腔镜胆囊切除术(LC)是可行的。     

急诊腹腔镜胆囊切除术中放置腹腔引流的作用

目的：探讨腹腔引流在急性胆囊炎的腹腔镜胆囊切除术中的作用。方法：对我科1994年以来经腹腔镜治疗急性胆囊炎145例进行回顾性分析。结果：本组145例，放置腹腔引流63例，胆漏1例，大网膜损伤出血1例，胆囊动脉出血2例，肝下积脓1例。结论：急性胆囊炎的腹腔镜胆囊切除术放置腹腔引流是必要的，但有一定指征。     

手术治疗78例急性胆囊炎的临床分析

目的：对78例急性胆囊炎患者的手术情况进行回顾性分析，探讨急性胆囊炎手术治疗的指征、时机及式。方法：对急性结石性胆囊炎66例和急性非结石性胆囊炎12例患者行单纯胆囊切除63例、肛囊切除加胆道探查7例、胆囊大部切除5例、胆囊造口3例。结果：全部病例均治愈出院。术后并发胆漏1例、伤口感染3例、胆管炎1例，切口脂肪液化3例，切口部分裂开1例。结论：对急性胆囊炎的治疗应明确手术指征，把握好手术时机。围手术期的合理处理及手术技巧是保证手术顺利成功的重要因素。     

腹腔镜胆囊切除术后并发胆漏的原因分析

目的:探讨腹腔镜胆囊切除术(LC)后并发胆漏的原因及其治疗及预防方法。方法:1994年6月—2012年6月收治的4860例LC的患者中,20例患者术后并发胆漏,回顾分析20例并发胆漏的患者的临床资料。结果:20例中10例于LC术中预防性放置腹腔引流管,8例引流畅通,引流3～21 d后痊愈;2例引流不畅。引流不畅的2例患者以及未预防性放置腹腔引流管的10例患者(共12例),均于再次手术后痊愈。随访2年,所有患者均无后遗症发生。结论:LC并发胆漏较为常见,应重视胆漏的预防。胆漏一旦发生,术中置有腹腔引流管的患者只要保持引流畅通多能痊愈;无腹腔引流或引流不畅的患者如确诊为局限性或弥漫性胆汁性腹膜炎,应立即再次手术,也可取得良好效果。     

腹腔镜胆囊切除术103例体会

目的 :回顾总结腹腔镜胆囊切除术 (LaparoscopicCholecystectomy ,LC)的体会。方法 :手术采取四孔操作法。结果 :完成(LC) 10 3例 ,中转开腹 5例 ,7例肝下小网膜孔置引流管 ,术后中毒性休克 1例 ,全部病例均治愈。结论 :严格规范化培训 ,开展初期从严掌握手术指征 ,采取正确的胆囊三角解剖技巧 ,适时中转开腹 ,合理放置引流 ,是安全开展LC的最根本保证。     

胆囊颈部结石嵌顿的腹腔镜处理

目的总结胆囊颈部结石嵌顿行LC的经验,提高LC的成功率。方法回顾性分析76例LC的临床资料。结果72例完成LC术,4例中转手术。1例术后出现胆漏,经腹腔引流管引流治愈,无术后出血、胆道损伤等严重并发症,所有病例均痊愈出院。结论仔细、熟练的LC操作技术是胆囊颈部结石嵌顿性胆囊炎LC成功的关键,胆囊颈部结石嵌顿性胆囊炎行LC是可行的。     

胆囊急性炎症期行腹腔镜胆囊切除术的处理技巧

目的探讨胆囊急性炎症期行腹腔镜胆囊切除术(LC)中胆囊管和胆囊动脉的处理方法。方法对1579例胆囊急性炎症期行LC手术的患者临床病历进行回顾性分析。结果胆囊管和动脉丝线结扎组1359例术后仅发生胆囊床胆漏1例,经再次手术引流治愈。胆囊颈管缝合组125例术后出现严重胆漏2例,经保守治疗治愈;小胆囊形成伴胆囊管残余结石1例再次开腹手术切除治愈。胆囊管未作特殊处理组43例术后出现胆漏2例,均经保守治疗治愈;活动性出血1例经开腹手术止血治愈;肝下积液继发感染1例,经穿刺置管引流治愈。完成腹腔镜手术组共1527例,其中术后近期发生严重并发症7例(0·46%),全组均治愈出院。结论在胆囊急性炎症期LC术中,采用结扎或缝扎胆囊管和胆囊动脉等处理技巧可降低术中风险,减少中转开腹手术率和术后并发症发生率。     

腹腔镜下胆囊切除术后腹腔引流探讨

腹腔镜胆囊切除术（LC）后是否置放腹腔引流以及其利弊探讨少有报道，该文总结了1996年2月－1998年2月所施475例LC术病人中72例置放腹腔引流管的优缺点，认为LC术置放腹腔引流指征应适当放宽，在犹豫不决时应果断放置引流管，因为它有利于早期发现并早期治疗LC术后并发症。是观察LC术后并发症较好的方法。     

急性结石性胆囊炎腹腔镜胆囊切除手术临床分析

目的探讨结石性胆囊炎急性炎症期腹腔镜胆囊切除术（LC）的手术技巧及手术指征。方法对急性炎症期LC 221例与同期急性炎症期开腹胆囊切除术（OC）158例作对照,回顾性总结379例急性结石性胆囊炎手术治疗临床资料,体会炎症期LC手术技巧。结果LC组术中情况、切口感染情况、术后平均住院时间均优于OC组。结论急性炎症期LC在具备熟练手术技巧时,是一种安全有效的术式。     

1例心脏外科术后并发急性非结石性胆囊炎患者的护理

急性非结石性胆囊炎（AAC）指经影像学检查、手术及病理均未发现胆囊内有结石的急性胆囊炎。AAC可并发于与胆道无关的各种手术，在心脏外科术后发生率低，死亡率高。本科对1例心脏外科术后并发AAC的患者进行护理，效果满意。现报告如下。     

LAPAROSCOPIC TREATMENT OF ACUTE CHOLECYSTITIS

Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery. Methods: From December 1996 to December 2001, 138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age: 45.3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26 %were empyema, 13 % had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15.2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6 : 15. There was no significant difference in operative time (122.0 min in 1 group versus 124.0 min in 2 group) and postoperative stay ( 5.1 days in group 1 vs 6.8 days in group 2). The hepatorenal space was drained in 78 (56.5 % ), and the drain is removed in 3rd postoperative days. Twenty six patients (18.8%) had undergone previous abdominal surgery. Thirty seven patients (26.8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense, thus increasing the technical difficulty of LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and effective for acute cholecystitis even when complicated previous surgery, inflammatory adhesions and gangrene. LC has significantly fewer operative complications and provides shorter hospital stay which are medical and economic benefits. LC is safe and effective for acute cholecystitis.     

老年人急性胆囊炎腹腔镜胆囊切除术50例临床分析

目的探讨老年人急性胆囊炎的腹腔镜治疗特点。方法将我院2002年1月至2006年12月收治的50例腹腔镜胆囊切除术（LC）老年病例急性发作期（48～72h内）,与非老年人组50例进行比较分析。结果老年人组较非老年人组LC手术时间,平均住院时间延长;LC中转开腹胆囊切除术（OC）率两组无差异。结论严格把握LC适应证,老年急性胆囊炎病人可早期施行LC。     

Perceptual-motor coordination in persons with mild intellectual disability

Background. There is limited experimental evidence to support the view that individuals with intellectual disabilities (ID) have a deficit in motor control. This work is a first attempt to evaluate their motor coordination.

Purpose. The study assessed the relationship between cognitive ability and sensorimotor integration. The clinical hypothesis is that adults with ID fall below non-ID adults in motor skills that involve hand-eye coordination.

Method. A group of 42 adults with ID (ID group) was compared to 48 age-matched typical adults (TA) using a mixed experimental design ('Task' as the within-subjects factor and 'Group' as the between-subjects factor). Participants performed the following tests twice: Box-and-Blocks, 25-Grooved-Pegboard, Stick Catching and overhead Beanbag-Throw. Pearson correlations and ANOVAs were used to test the hypothesis (p ≤ 0.05).

Results. As expected, TA outperformed the ID group in all tests regardless of the hand used during for the assessment. However, TA individuals scored significantly better with one hand (i.e., the preferred and dominant hand) as opposed to persons with ID, who exhibited no hand preference. Test-retest correlations among the first and second assessment scores yielded moderate-strong coefficients, depending on the type of test (Box-and-Blocks = 0.92 and 0.96, 25-Grooved-Pegboard = 0.69 and 0.83, Stick-Catching = 0.88 and 0.94, Beanbag-Throw = 0.58 and 0.91 for ID and TA, respectively).

Discussion. Difficulties in the integration of perceptual information into motor action may result in inadequate solutions to daily motor problems. As it stems from our results, intellectual disability relates to inability to integrate visual inputs and hand movements. In people with mild ID such inability is observed using both hands (i.e., they show no hand preferences). Poor perceptual-motor coordination might have a functional significance in that it may lead to exclusion from vocational and recreational activities, and a decreasing competence of ADL. Assessing coordination in adults with ID may contribute to understanding the nature of the ID condition and may encourage an early rehabilitation.     

急性胆囊炎腹腔镜胆囊切除术

目的：为评价LC在AC时应用的安全性和有效性。方法：本文总结了1995年5月到1996年5月46例AC患者应用LC的结果，并与同期457例择期LC比较。结果：46例AC中42例LC成功，与同期择期LC的成功率无显著差别。但AC病例中LC所需时间较长，二者并发症发生率基本相同。结论：LC适合于大多数AC患者，但必须有经验的外科医生完成。     

急性胆囊炎行腹腔镜胆囊切除时术中胆道造影35例分析

目的:探讨急诊腹腔镜胆囊切除术(LC)时行术中胆道造影对胆总管结石的诊断价值,了解IOC在急诊LC时的可行性和安全性。方法:37例术前B超或CT未发现胆总管结石的急性胆囊炎病例行LC,均行经胆囊管胆道造影。结果:35例胆道造影成功,发现3例胆总管结石病例,分别为4mm、3mm、3mm大小,于术后行内镜取石成功。该组病例中无胆道损伤,发生1例与胆道造影无关的轻微胆漏。结论:急性胆囊炎行LC时,并发隐匿性胆管结石的情况值得重视,IOC在急诊LC时对胆管结石的诊断是安全可行的。     

Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients

BACKGROUND AND STUDY AIMS: How to approach common bile-duct (CBD) stones discovered during laparoscopic cholecystectomy (LC) is still a subject for debate. After sequential strategies, the natural trend is now towards single-stage therapy. The aim of this study was to establish the feasibility of intraoperative endoscopic sphincterotomy (IOES) when CBD stones are discovered or strongly suspected on intraoperative cholangiography (IOC) during LC. PATIENTS AND METHODS: Out of a total of 2193 laparoscopic cholecystectomies, we reviewed 57 patients who, between 1991 and 1999, underwent IOES just after LC during the same anesthetic session. Under fluoroscopic guidance, one group of 32 patients (Dijon) underwent IOES in the prone position and a second group of 25 patients (Poitiers) in the left lateral position. RESULTS: IOES was successful in all cases (100%). CBD stones were definitively found in 49 cases (86%) but retrieved or released into the duodenum after IOES in only 46 cases (46/49, 93.9%). The mean duration of the intraoperative endoscopic procedure was 28 minutes (range 15-75). The short-term complication rate was 7%. The mean postoperative hospital stay was 5.3 days (range 2-14). CONCLUSIONS: IOES performed after LC during the same anesthetic session is feasible with low risk and with good results. It offers the opportunity to treat in one stage both cholecystolithiasis and choledocholithiasis without the need for surgical CBD exploration.     

Anatomic M-mode echocardiography: A new approach to assess regional myocardial function--A comparative in vivo and in vitro study of both fundamental and second harmonic imaging modes.

OBJECTIVE: To evaluate the accuracy of anatomic M-mode echocardiography (AMM). METHODS: Eight phantoms were rotated on a device at different insonation depths (IDs) in a water beaker. They were insonated with different transducer frequencies in fundamental imaging (FI) and second harmonic imaging (SHI), and the diameters were assessed with conventional M-mode echocardiography (CMM) and AMM with the applied angle correction (AC) after rotation. In addition, left ventricular wall dimensions were measured with CMM and AMM in FI and SHI in 10 volunteers. RESULTS: AC had the greatest effect on the measurement error in AMM followed by ID (AC: R2 = 0. 295, ID: R2 = 0.268; P <.0001). SHI improved the accuracy, and a difference no longer existed between CMM and AMM with an AC up to 60 degrees. In vivo the limit of agreement between AMM and CMM was -1.7 to +1.8 mm in SHI. CONCLUSION: Within its limitations (AC < 60 degrees; ID < 20 cm), AMM could be a robust tool in clinical practice.     

经皮胆囊镜超声碎石术后腹腔镜胆囊切除术83例报告

目的探讨经皮胆囊镜超声碎石术后再次行腹腔镜胆囊切除术的手术方法、适应证和禁忌证。方法回顾分析83例经皮胆囊超声碎石术后患者行腹腔镜胆囊切除术的临床资料。结果83例中77例顺利完成腹腔镜胆囊切除术，6例中转开腹手术。结论对有腹部手术史的病人行腹腔镜手术具有创伤小、痛苦轻、恢复快、不影响切口愈合等优越性。     

Single-port versus needlescopic versus conventional laparoscopic cholecystectomy: a comparative study

Introduction: Single‐port laparoscopic cholecystectomy (LC) has been recently introduced to achieve clinical benefits over standard LC. However, surgical outcomes of this operation have been poorly described compared with current techniques. The purpose of this study is to evaluate the surgical outcomes of single‐port LC compared with needlescopic and conventional LC. Methods: We reviewed the surgical outcomes of consecutive patients with symptomatic gallbladder stone disease who underwent single‐port LC (31 cases), needlescopic LC (26 cases) and conventional LC (32 cases) from March 2009 to January 2010. Operation time, hospital stay, conversion, complications, and postoperative pain using visual analog scale were analyzed. In addition, patients were interviewed for overall satisfaction and cosmetic results. Results: BMI in the single‐port group was significantly lower than in the conventional group (26.0 ± 4.0 vs 30.8 ± 7.3 kg/m², P=0.0017). Operation time in the single‐port group was significantly longer than in the conventional group (65.1 ± 20.1 minutes vs 52.2 ± 19.6 minutes, P=0.012). There was one conversion in the single‐port group. In nine cases in the single‐port group (29%), a Kirschner wire or a suture retractor helped visualization. There was one complication in the single‐port group (wound infection) and one in the needlescopic group (bile leak, requiring laparoscopy). Hospital stay, visual analog scale scores, and overall satisfaction did not vary among these groups. Greater cosmetic satisfaction was shown in the single‐port group compared with the conventional group (P=0.039). Conclusion: Single‐port LC is feasible and secure, with better cosmetic results than conventional LC. Further prospective randomized studies are still required to show its superiority over current LC techniques.     

脊柱内镜与开放减压融合术对年轻肥胖腰椎间盘突出症病人的疗效对照研究

目的:评估脊柱内镜下减压手术与开放减压固定融合手术治疗年轻肥胖腰椎间盘突出症病人的中期临床疗效。方法:回顾分析2015年1月至2017年6月期间在我院疼痛科及骨科脊柱组确诊为腰椎间盘突出症并接受手术治疗的病人。以年龄18~45岁,BMI≥28 kg/m^2,因腰椎间盘突出症而接受手术治疗为入组标准。根据病人接受术式不同分为内镜组(62例)及开放组(25例)。以术前及术后24个月视觉模拟评分法(visual analogue scale,VAS)评分、手术时间、术中出血量、重返工作时间、MacNab评分、术后再手术率作为评价指标,分析两组差异,比较两术式的临床疗效。结果:内镜组62例病人平均年龄(31.2±8.2)岁,平均BMI值为(30.8±3.1)kg/m^2,平均重返工作时间(3.2±6.2)月,平均手术时间(68.5±36.6)分钟,平均出血量(5.1±4.2)ml。MacNab评分结果为优(50例)、良(5例)、可(1例)、差(6例),优良率88.7%。10例术复发再次接受手术(再手术率16.1%);开放组手术25例病人平均年龄(29.8±7.1)岁,平均BMI值为(31.6±3.7)kg/m^2,平均重返工作时间(5.7±4.2)月,平均手术时间(145.8±51.5)分钟,平均出血量(334.0±215.4)ml。MacNab评分结果为优(20例)、良(4例)、可(0例)、差(1例),优良率96.0%。1例术后症状复发接受翻修开放手术(再手术率4%)。两组病人年龄、BMI值和MacNab评分无统计学差异(P>0.05),重返工作时间、术后复发时间、出血量、手术时间有统计学差异(P<0.05),两组术后VAS评分均较术前明显下降。结论:对于年轻肥胖腰椎间盘突出症病人,脊柱内镜手术与开放减压固定融合术治疗均有明显疗效。而脊椎内镜术后出血量少、手术时间与恢复时间更短,病人能更快地重回工作恢复社会角色。此外,脊椎内镜术后二次手术率较开放减压固定融合术较高,推测脊柱内镜术后复发率较开放手术高。