腹腔镜与开腹胆囊切除术效果对比

目的比较腹腔镜与传统开腹胆囊切除术的效果。方法将60例胆囊良性疾病患者随机分为2组。对照组实施传统开腹手术,观察组患者实施腹腔镜胆囊切除术,观察比较2组临床治疗效果。结果 2组手术时间比较,差异无统计学意义(P0.05),观察组术中出血量、住院时间及术后并发症发生率等均优于对照组,2组比较,差异均有统计学意义(P0.05)。结论腹腔镜胆囊切除术创伤小、患者恢复快,是治疗胆囊良性疾病的首选术式。     

腹腔镜与开腹胆囊切除术的住院费用对比

目的　比较腹腔镜与开腹胆囊切除术的住院费用。　方法　LC开展初期 ( 1991年 )和成熟期 ( 2 0 0 0年 )选取LC10 0例与同一时期开腹胆囊切除术 (OC) 10 0例住院费用进行对比分析。　结果　LC开展初期 ,LC组住院费用总费用( 2 575 86± 2 61 61)元明显高于OC组 ( 12 40 61± 3 82 67)元 (t=2 8 80 5,P <0 0 0 1) ,主要与手术及材料费用高 (t =199 83 3 ,P <0 0 0 1)有关。LC开展成熟期 ,LC组住院费用总支出 ( 583 3 0 0± 464 97)元明显低于OC组 ( 7489 2 6± 2 491 2 4)元 (t=6 53 5,P <0 0 0 1) ,虽然手术及材料支出仍高 (t=17 0 2 9,P <0 0 0 1) ,但药品、床位、检查等项均低于OC组 (t值分别为 8 83 9、12 0 0 5、6 2 0 3 ,P <0 0 0 1)。　结论　随着LC技术的成熟 ,费用降低已成为其一大特点     

腹腔镜与开腹手术在胆囊切除术中的对比

目的对比研究腹腔镜与开腹手术在胆囊切除术中的效果。方法将沈丘县人民医院2005年1月至2006年12月收治的100例胆囊疾病患者,随机分为腹腔镜组和开腹组。腹腔镜组50例,采用四孔法引入腹腔镜器械切除胆囊;开腹手术组50例,采用用经右上腹直肌切口切除胆囊。结果腹腔镜手术组手术时间、、术中出血量、术后排气时间、术后镇痛药物应用、切口感染情况及住院时间明显优于开腹手术组(P<0.01)。结论腹腔镜胆囊切除术是治疗胆囊良性疾病的金标准。     

腹腔镜胆囊切除术与开腹胆囊切除术的比较

按顺序抽取腹腔镜胆囊切除术(LC)病历110份，开腹胆囊切除术(OC)病历136份，笔者就两组病例的手术时间、切口长度、出血量及住院天数等资料进行回顾性分析和比较，结果显示：LC组在手术时间、切口长度、出血量及住院天数均短于或少于OC组。提示：LC优于OC，值得在基层推广与普及。     

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。     

腹腔镜胆囊切除术和开腹胆囊切除术安全性临床分析

目的比较开腹胆囊切除术和腹腔镜胆囊切除术的安全性。方法回顾分析568例胆囊切除术病例。分为2组:A组为对照组,323例行开腹胆囊切除术;B组为实验组,245例行腹腔镜胆囊切除术。对比2组的手术成功率、手术时间、住院时间、术中及术后并发症发生情况。2组手术成功率之间比较用检验,2组手术时间和住院时间之间比较用t检验,P0.05差异有统计学意义。结果2组手术成功率之间,P0.05,差异无统计学意义;2组手术时间和住院时间之间比较,P0.05差异有统计学意义。结论术前正确选择病例、术中规范操作、术后注意观察可能出现的并发症是腹腔镜胆囊切除手术成功的关键。相比开腹手术而言,具有明显的优势。     

腹腔镜胆囊切除术与开腹胆囊切除术的临床特征及住院费用的对比

目的 对腹腔镜胆囊切除术的安全性，临床及经济价值作出评估。方法 对行ＬＣ的２７８例患者与开腹胆囊切除术的２３４例患者进行对比调查。结果 ＬＣ与ＯＣ具有相同的安全性；ＬＣ患者术后总的疼痛时间与严重疼痛时间，住院及出院后恢复工作的时间均明显短于ＯＣ患者；     

腹腔镜胆囊切除术中转开腹原因分析

<正> 腹腔镜胆囊切除术(LC)与传统胆囊切除术(OC)比较,具有创伤小,痛苦轻,恢复快等优点而得到迅速推广。但LC并不能完全代替OC, LC有其严格的适应症,部分病例在腹腔镜下无法完成,仍需中转开腹手术。我院行LC术186例,中转开腹13例(6.9％),本文就我院中转开腹手术的原因进行分析,探讨如何降低LC中转手术率。     

腹腔镜胆囊切除术与开腹胆囊切除术的效果比较

目的 比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与传统开腹胆囊切除术(open chole-cystectomy,OC)的手术效果.方法 128例患者中,64例施行LC,64例施行OC,比较两组手术的手术时间、术中出血量、术后排气等7项指标.结果 LC组手术时间、术中出血量、术后排气时间、术后镇痛药物应用、术后胃肠功能恢复时间、切口感染情况及住院时间明显优于OC组(P<0.01).结论 LC具有有创伤小、痛苦轻、恢复快等优越性.     

老年患者腹腔镜胆囊切除术与开腹胆囊切除术比较

目的对比研究老年良性胆囊疾病腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)与开腹胆囊切除(open cholecystectomy,OC)安全性,为老年人胆囊切除术式的选择提供依据. 方法 60岁以上有胆囊切除适应证且耐受全麻的老年患者120例,按住院顺序单双号分为LC组和OC组,每组60例,比较手术时间、止痛剂使用情况、术后胃肠功能恢复时间、输液时间、卧床时间、术后并发症、住院时间等围手术期指标,比较2组总T3、TSH水平,腹肌功能恢复等康复指标. 结果术后并发症、围手术期以及康复指标,LC组均优于OC组.TT3与术前相比,LC组(F=8.26,P=0.000)、OC组(F=124.70,P=0.000)均明显下降,OC组下降理明显;TSH与术前相比,LC组下降不明显(F=1.87,P=0.157),OC组下降明显(F=27.24,P=0.000).术后7 d直腿抬高试验次数LC组明显高于OC组(t=3.640,P=0.000) 结论老年良性胆囊疾病患者行LC优于OC.     

A financial analysis of laparoscopic and open cholecystectomy

Laparoscopic cholecystectomy (LC) is now the method of choice in treatment of symptomatic gallstone disease. Despite its rapidly growing popularity, comparative costs of this new method and open cholecystectomy (OC) remain unclear. The most outstanding feature of laparoscopic cholecystectomy is the period of short recovery. In Sweden the social insurance office documents sick leave period, sickness allowance, as well as diagnosis and therefore provides a reliable basis for an economic analysis. The purpose of this study was to estimate the hospital cost and costs due to sick leave in a series of patients operated on with elective cholecystectomy using the two methods. In each group 50 consecutive patients were studied retrospectively. The total hospital cost was 10% lower in the laparoscopy group—$1,864 as compared to $2,030 per patient in the OC group. Median number of days off work was 14 after LC and 35 days after open surgery, which corresponds to a median sickness allowance of $516 per patient (LC) compared to $1,424 (OC). Laparoscopic cholecystectomy is more cost-effective than open cholecystectomy mainly due to a reduced sick leave period.     

腹腔镜胆囊切除术与开腹胆囊切除术对肝功能影响的比较研究

目的 对腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）手术前后肝功能的临床资料进行对比研究，旨在观察术后肝功能变化规律及两种术式对肝功能的影响有无差异，并为今后手术病例及术式选择提供依据。方法 选择胆囊良性病变且肝功能正常需行胆囊切除术者作为研究对象。将30例病人分为LC组和OC组，并分别按开放法或腹腔镜方法实施胆囊切除术。术前、术后第1、3、7天，分别取空腹外周静脉血测定肝功能指标，包括ALT、AST、TBIL、DBIL、GGT、ALB、ALP。结果 两组病人年龄构成及术前肝功能无显著差异，LC与OC术后各项指标变化趋势相同。LC与OC术后血清ALT、AST、TBIL均较术前升高；上述指标术后第3天即明显下降，至术后第7天达正常水平，且所有病人术后顺利恢复。LC与OC术后血清ALB均有下降，血清DBIL、GGT、ALP均无显著变化。结论 本研究结果表明：（1）LC与OC对肝功能均有影响，但仅为一过性现象，不影响病人恢复；（2）在全麻下，腹腔内气腹压力为12～15mmHg时，LC对肝功能的影响与OC相比无显著性差异，说明在此情况下施行LC是安全的。     

胆囊结石并肝硬化行腹腔镜与开腹胆囊切除比较

目的对比合并肝硬化的胆囊结石症行腹腔镜胆囊切除与开腹胆囊切除术的疗效。方法回顾性分析我院1999～2004年25例合并肝硬化的症状性胆囊结石患者,其中13例行LC,12例行OC。结果13例LC患者1例出现肺部感染;12例OC患者术后切口感染1例,肺部感染3例,切口渗液4例,尿路感染3例;术中出血量LC组明显少于OC组P<0.0.5;术后住院时间LC组明显短于OC组P<0.0.5。结论LC治疗合并肝硬化的症状性胆囊结石症,具有明显的优点,与OC相比,LC手术时间短,手术出血量少,术后并发症发生率低,同时缩短了住院时间,在肝硬化ChildA鄄B级病人中安全可靠。     

Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement

To evaluate the benefits and safety of laparoscopic cholecystectomy (LC) in patients with cardiac valve replacement (which frequently leads to cholelithiasis), 12 patients with cholelithiasis associated with cardiac valve replacement were studied. The patients were divided into two groups, of 6 patients each, according to the type of operation performed, open cholecystectomy (OC) or LC. The postoperative course was monitored with respect to laboratory data on postoperative days (POD) 1, 3, and 7. The mean duration of operation, blood loss, days to food resumption, length of hospital stay, and morbidity were compared between the two groups. Significant differences (P < 0.05) were found between the OC and LC groups in white blood cell counts on POD 1 (12 980 ± 3040/mm³ vs 8300 ± 1590/mm³), days to food resumption (2.7 ± 0.4 days vs 1.0 ± 0.7 days), and length of postoperative stay (15.8 ± 1.0 days vs 10.8 ± 1.6 days). There were no complications in the LC group, but 1 patient in the OC group had heart failure postoperatively. Our findings indicate the efficacy and safety of LC in patients with cardiac valve replacement. Received: August 14, 2000 / Accepted: December 22, 2000     

Conversion of laparoscopic to open cholecystectomy

Background: Identifying patients who are at risk for conversion from laparoscopic (LC) to open cholecystectomy (OC) has proven to be difficult. The purpose of this review was to identify factors that may be predictive of cases which will require conversion to laparotomy for completion of cholecystectomy. Methods: We reviewed 581 LCs initiated between July 1990 and August 1993 at a university medical center and recorded reasons for conversion to OC. Statistical analysis was then performed to identify factors predictive of increased risk for conversion. Results: Of the 581 LC initiated, 45 (8%) required OC for completion. Reasons for conversion included technical and mandatory reasons and equipment failure. By multivariate analysis, statistically significant risk factors for conversion included increasing age, acute cholecystitis, a history of previous upper abdominal surgery, and being a patient at the Veterans Affairs Medical Center (VAMC). Factors not increasing risk of conversion included gender and operating surgeon. Conclusions: We conclude that no factor alone can reliably predict unsuccessful LC, but that combinations of increasing age, acute cholecystitis, previous upper abdominal surgery, and VAMC patient result in high conversion rates. Patients with the defined risk factors may be counseled on the increased likelihood of conversion. However, LC can be safely initiated for gallbladder removal with no excess morbidity or mortality should conversion be required.     

Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study

Background This randomized study aimed to compare the reaction of the immune system to the process of postoperative adhesion formation after open and laparoscopic cholecystectomy. Methods In this study, 20 mongrel dogs were used: 10 each in the laparoscopic and open cholecystectomy groups. Blood and peritoneal lavage samples were taken up to postoperative day 14, followed by second-look laparoscopy and reoperation to detect the rate of adhesion formation. Also, specimens were obtained from the liver bed for histology. Results In the open cholecystectomy group, the white blood cell count was higher in blood samples and lower in lavage specimens. Adhesion formation was extensive, and the histologic immune reaction was more intensive in the open cholecystectomy group. Conclusion This randomized study proved that laparoscopic cholecystectomy was associated with less immune suppression, less inflammatory reaction, and therefore less adhesion formation than open cholecystectomy.     

Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy

In an attempt to quantify the difference in tissue damage between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), we have compared in a prospective manner the pre- and postoperative concentrations of serum C-reactive protein (CRP) in 17 patients undergoing LC and 13 patients undergoing OC. In addition, we measured the pre- and postoperative white blood cell counts (WBC), the postoperative body temperature, and the postoperative duration of hospitalization. There were no differences in the preoperative serum CRP concentrations—5.9±2.62 mg/l (mean±SD) for the LC group and 6.12±2.38 mg/l for the OC group.Serum CRP rose markedly following OC compared to that of patients who underwent LC (128.6±45.1 mg/l vs 26.8±10.5 mg/l) (P<0.001). There were also significant differences in the postoperative WBC count (14,000±2,900 cells for the OC group vs 10,600±3,000 cells for the LC group), the postoperative body temperature (37.5±0.3°C vs 37.0±0.3°C), and the postoperative hospital stay (5.5±1.5 days vs 1.9±0.9 days). There was no correlation between serum CRP concentrations and the other postoperative parameters.These results provide us with biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.