小切口胆囊切除术50例疗效分析

目的总结小切口胆囊切除术的疗效。方法2007年1月至2008年12月我院选择性施行小切口胆囊切除术50例，对其临床资料进行回顾性分析。结果术后并发症：切口感染1例，切口脂肪液化1例，粘连性肠梗阻1例，胆瘘1例，经对症处理痊愈出院。结论小切口胆囊切除术具有腹腔镜切除术的创伤小、痛苦少、恢复快等优点，值得推广。     

改良小切口胆囊切除术在基层医院的临床应用

目的分析改良小切口胆囊切除术(MC)在基层医院的临床应用。方法回顾性分析我院2005年1月至2008年12月我院选择性施行改良小切口胆囊切除术42例的资料。结果本组均采用小切口顺利完成手术,平均手术时间72 min。术后并发症:切口感染1例,切口脂肪液化1例,粘连性肠梗阻1例,胆瘘1例,经对症处理痊愈出院。结论小切口胆囊切除术具有腹腔镜切除术的创伤小、痛苦少、恢复快、瘢痕小、安全性高、并发症少、无需特殊器械等优点,适合于广大基层医院开展。     

208例小切口胆囊切除术的临床分析

报道1995年5月-2001年10月小切口胆囊切除术208例，并发症10例，并发症率4.8％(10／208)，其中腹腔内出血1例，胆总管横断1例，胆漏2例，胆总管残留结石3例，胆囊管残留过长3例。认为小切口胆囊切除术应慎用。     

小切口胆囊切除术60例体会

目的　探讨小切口胆囊切除术的临床应用价值。方法　回顾总结 6 0例小切口胆囊切除术的临床资料。结果　腹壁切口长度 4～ 7cm。 6 0例均治愈 ,术后平均住院 4.8d。 2 8例随访 1～ 4年 ,切口疤痕较小。结论　小切口胆囊切除术适用于单纯胆囊良性病变 ,值得推广运用     

小切口胆囊切除术手术技巧与疗效分析

目的探讨小切口胆囊切除术的手术技巧与疗效。方法回顾性分析我院2001年6月至2009年6月期间672例小切口胆囊切除术的应用情况,重点介绍围手术期处理及手术技巧。结果672例小切口胆囊切除术中,手术成功652例(97.0%),延长切口20例(3.0%)。手术时间为(40.0±10.0)min。术中发生大出血1例,予以介入栓塞治疗成功止血;肝外胆管损伤1例,术中予以修补,放置T管。术后2例患者出现漏胆,予以保守治疗成功;无切口感染,无围手术期死亡患者。结论在传统胆囊切除术熟练的基础上,严格掌握手术适应证,提高手术技巧,开展小切口胆囊切除术是经济、安全、可行的。     

小切口胆囊切除术的临床应用

开腹胆囊切除术自1882年实施以来，被证明为安全有效的手术方式。目前胆囊切除术主要采用传统手术、小切口手术(MC)及腹腔镜手术3种方式。1982年法国Dubois曾介绍过小切口胆囊切除术，但未能引起外科界重视，1987年Jean Mouret首次用腹腔镜胆囊切除术(LC)后，小切口胆囊切除术才引起人们关注。我院自1998年1月-2004年1月间共实施小切口胆囊切除术268例，现总结经验报告如下。     

小切口胆囊切除术86例临床体会

目的探讨采用小切口胆囊切除术治疗胆囊疾病的效果。方法对86例胆囊疾病患者行小切口胆囊切除术,回顾性分析患者的临床资料。结果本组86例患者均痊愈出院。结论采用小切口胆囊切除术治疗胆囊疾病,具有创伤小、恢复快、痛苦小、住院时间短、经济负担轻特点,值得在基层医院推广应用。     

小切口胆囊切除术复杂情况的处理

目的 总结小切口胆囊切除术的临床经验。探讨小切口胆囊切除术中复杂情况的处理方法及手术安全性。方法 回顾性分析我院2002年1月～2007年6月行小切口胆囊切除术患者的临床资料。结果 全组136例，131例成功行小切口胆囊切除术，5例延长切口完成手术，全部治愈出院，无并发症发生。结论 对于复杂情况的胆囊炎患者，只要方法得当，小切口胆囊切除术仍是一种安全有效的手术方法。     

急性结石性胆囊炎行小切口胆囊切除术与腹腔镜胆囊切除术的疗效分析

目的:分析腹腔镜胆囊切除术与小切口胆囊切除术治疗急性结石性胆囊炎的临床效果.方法:回顾总结2017年5月至2019年8月手术治疗的61例急性结石性胆囊炎患者的临床资料,42例行腹腔镜胆囊切除术(腹腔镜组),19例行开腹小切口胆囊切除术(小切口组).比较两组手术时间、术中出血量、切口长度、术后第1天疼痛评分、引流管留置时...     

胆囊切除应慎用小切口--208例小切口胆囊切除术的临床分析

报道1995年5月～2001年10月小切口胆囊切除术208例,并发症10例,并发症率4.8%(10/208),其中腹腔内出血1例,胆总管横断1例,胆漏2例,胆总管残留结石3例,胆囊管残留过长3例.认为小切口胆囊切除术应慎用.     

A prospective study of bile leaks after laparoscopic cholecystectomy

Since laparoscopic cholecystectomy rapidly became the gold standard, there is an increased morbidity of 1% to 3% for clinically significant bile leaks with this procedure, as compared with open cholecystectomy (<1%). The identification of subclinical bile leaks using cholescintigraphy occurs in the range from 31.4% to 40% after elective open cholecystectomy. At this writing, no studies exist that document the rate of subclinical bile leaks after elective laparoscopic cholecystectomy. In this study, 71 patients were evaluated using cholescintigraphy after elective laparoscopic cholecystectomy. This study represents the first prospective look at the rate of subclinical bile leaks after laparoscopic cholecystectomy in elective cases, and the findings show an overall incidence of 7.3%, as compared with historical reports of 30% to 44% for open cholecystectomy.     

A prospective study of bile leaks after laparoscopic cholecystectomy for acute cholecystitis

Surgeons are increasingly performing laparoscopic cholecystectomy in the setting of acute cholecystitis. The acutely inflamed gallbladder poses a more technically demanding dissection with potential for an increase in bile leak rates. Clinical and subclinical bile leak rates after laparoscopic and open cholecystectomy in the elective setting are known. This study prospectively evaluates the rate of clinical and subclinical bile leaks after laparoscopic cholecystectomy in the setting of acute cholecystitis. One hundred patients underwent laparoscopic cholecystectomy for acute cholecystitis, as determined intraoperatively and by history, ultrasound, fever, or leukocytosis. On postoperative Day 1, the patients underwent cholescintigraphy (PIPIDA scan) analyzed by a board-certified radiologist for evidence of bile leaks. Postoperative cholescintigraphy revealed eight scans positive for bile leaks. Regardless of scan result, no patient experienced a clinically symptomatic bile leak. Laparoscopic cholecystectomy is a safe and effective treatment for acute cholecystitis with acceptable clinical and subclinical bile leak rates.     

Prolonged secretion of lithogenic bile after cholecystectomy.

Hepatic bile samples were obtained from 8 subjects 1 1/2 to 23 years after cholecystectomy for presumed cholesterol gallstones. The content of cholesterol, bile acids and lecithin was determined for each bile sample and compared to the values found in gallbladder bile in 15 control subjects undergoing cholecystectomy for pure and mixed cholesterol stones. Plot of the data on triangular coordinates and subsequent determination of lithogenic index showed that bile was supersaturated with cholesterol in both groups of patients. The cholesterol content of bile remained at supersaturated levels following cholecystectomy and showed no tendency to return toward normal levels with the passage of time.     

Long-term results after cholecystectomy alone for patients with pancreaticobiliary maljunction without bile duct dilatation

A pancreaticobiliary maljunction (PB-MJ) without bile duct dilatation is relatively rare. The standard treatment for these patients remains controversial. In this study, we followed up the patients with PB-MJ without bile duct dilatation who mainly underwent a cholecystectomy alone. Eighteen adult patients with PB-MJ without bile duct dilatation (8 males and 10 females with a mean age of 54.8 years) were treated surgically. When the diameter of the common bile duct was less than 10 mm, such bile ducts were diagnosed to have no dilatation. The main clinical indications for surgery were cholecystolithiasis in 12 patients, choledocholithiasis in 3, cholecystocholedocholithiasis in 1, and carcinoma of the gallbladder in 2. The amylase levels of gallbladder bile in 14 patients ranged from 115 to 454,000 IU/ml. A simple cholecystectomy was performed in 12 patients, a cholecystectomy with bile duct drainage was performed in 3, a cholecystectomy with a choledochojejunostomy without bile duct resection was performed in 1, and a cholecystectomy with a lymph node dissection was performed in 2. Three patients died of other diseases. The remaining 15 patients have all been doing well for 20-209 months after surgery. In conclusion, a prophylactic resection of the extrahepatic bile duct and biliary diversion could be unnecessary for patients with PB-MJ without bile duct dilatation, when no bile stasis, such as choledocholithiasis, is observed.     

胆囊切除术的高危因素与医源性胆管损伤(附12例临床分析)

目的分析胆囊切除术中易发生胆管损伤的高危因素,探讨损伤的原因及预防措施。方法统计１９８５年１月至１９９８年７月行胆囊切除术时发生的１２例医源性胆管损伤情况,分析与致伤有关的解剖病理因素。结果１３年中行胆囊切除４８５４例中,易致胆管损伤的高危因素有７种共４９３例,其中高位胆囊３５例损伤１例,左右肝管低位汇合４７例损伤１例,胆囊动脉变异４７例损伤１例,萎缩性胆囊炎８７例损伤１例,胆囊颈结石嵌顿１７３例损伤４例,Ｍｉｒｉｚｚｉ综合征８９例损伤３例,伴门静脉高压症１５例损伤１例。结论在上述高危情况下,行胆囊切除术者易发生医源性胆管损伤。术者应保持警惕,仔细解剖清楚,术中造影、胆道探查以及逆行胆囊切除加胆囊颈部特殊处理等有助于减少医源性胆管损伤的发生。     

Endoscopic management of common bile duct stones leaving the gallbladder in situ. A cohort study with long-term follow-up

BACKGROUND: Obstructive jaundice caused by stones is a common disorder, mostly managed by endoscopic sphincterotomy followed by cholecystectomy. The aim of this study was to evaluate whether or not clearance of the common bile duct alone is sufficient as treatment for patients with choledocholithiasis. METHODS: A cohort with 447 patients with symptomatic cholecystocholedocholithiasis, undergoing endoscopic retrograde cholangiography (ERC) and if necessary sphincterotomy (ES). In 164 patients common bile duct stones were proven and treated endoscopically, without performing a subsequent cholecystectomy. All 164 patients were free of symptoms after the endoscopic intervention. This group of patients was compared with 78 patients who underwent cholecystectomy after endoscopic treatment of common bile duct stones. Patients were followed for 1-13 years after ERC and sphincterotomy results and complications were registered. RESULTS: The ages of the 164 patients in the in situ group were significantly higher than in the cholecystectomy group and the ASA classification (American Society of Anesthesiologists) was significantly higher in the in situ patients. Mean follow-up was 70.9 months. Of the in situ patients 27 (16%) returned with biliary symptoms; 12 with common bile duct stones, three with cholangitis, and one with stenosis of Vater's papilla. Eight patients returned with cholecystitis and 3 with symptomatic cholecystolithiasis. Thirteen patients underwent cholecystectomy and 11 were managed (also) endoscopically. Minor complications were 2 wound infections and 1 bleeding after cholecystectomy. Two patients (1%) died of abdominal sepsis due to cholecystitis. Of the patients who underwent cholecystectomy, 6 (7.6%) returned during follow-up. Three patients had common bile duct stones, 2 had cholangitis and 1 patient presented with papillostenosis. Three patients needed surgical common bile duct exploration and the other 3 were treated endoscopically. After reintervention, cardiopulmonary complications were observed in 1 patient. There was no related death. CONCLUSION: When common bile duct stones are treated successfully by endoscopic sphincterotomy and patients are free of symptoms, there is no need for routine prophylactic cholecystectomy.     

胆囊切除术后胆漏25例诊治体会

目的探讨胆囊切除术后发生胆漏的原因及其预防措施和治疗方法。方法回顾性分析我院1997年5月-2007年7月胆囊切除术后胆漏25例的临床资料。结果本组25例中，经保守治疗和再次手术各治愈12例，死亡1例。结论胆囊切除术后胆漏可经保守治疗和再次手术治愈。应根据胆漏的具体原因采用不同的处理方法。     

腹腔镜胆囊切除术中胆管损伤的预防

目的总结腹腔镜胆囊切除术中胆管损伤的原因及其防治方法. 方法回顾分析1 000例腹腔镜胆囊切除术临床资料. 结果中转开腹手术15例(1.5%);并发症6例(0.6%),其中胆总管损伤3例,胃穿刺损伤1例,腹壁刺口出血1例,胆漏1例.无远期并发症. 结论胆道牵拉成角是胆管损伤最常见原因.     

术中胆道造影在小切口胆囊切除术中的应用价值(附1042例报告)

目的：探讨术中胆道造影在小切口胆囊切除术中的应用价值。方法：共施行小切口胆囊切除术10020例,按相对胆管探查指征标准,施行1042例术中胆道造影：胆囊切除前经胆囊管造影、胆囊切除后经胆囊管造影及穿刺胆（肝）总管造影第三种。结果：发现病变119例,其中胆管结石113例,胆管变异4例,肝门部肿瘤2例。造影阳性率11．4％。结论：术中胆道造影能降低胆道阴性探查率、提供胆道解剖学依据、预防并及时发现胆道损伤,在小切口胆囊切除术中有重要作用。     

胆囊结石合并胆总管结石两种微创治疗术式的应用体会

目的探讨微创技术在治疗胆囊结石合并胆总管结石的手术方式的选择。方法回顾性分析2004年1月至2009年12月采用腹腔镜胆囊切除联合内镜下Oddi括约肌切开取石术(lapa-roscopic cholecystectomy combined with endoscopic sphincterectomy,LC+EST)和腹腔镜胆囊切除、胆总管探查术(laparoscopic cholecystectomy with laparoscopic common bile duct exploration,LC+LCBDE)治疗胆囊结石合并胆总管结石的资料。结果 LC+EST应用在2004-2006年与2007-2009年各3年度治疗效果对比:手术并发症、手术成功且无手术并发症例数差异均有统计学意义(P0.05),而中转开腹例数差异无统计学意义(P0.05)。LC+LCBDE应用在2004-2006年与2007-2009年各3年度治疗效果对比:手术并发症、手术成功且无手术并发症及中转开腹例数差异均有统计学意义(P0.05)。LC+EST和LC+LCBDE在治疗效果上对比:手术并发症、手术成功且无手术并发症及中转开腹例数差异均无统计学意义(P0.05)。结论胆石病的微创治疗方式与术者熟练程度有关。LC+EST、LC+LCBDE有着不同的适应证范围:LC+EST术式宜用于结石小于1.5cm,发生部位为肝胆管以下平面,并且胰腺段胆总管结石病人选择LC+EST术式更为合理;LC+LCBDE术式适宜于胆总管扩张超过1.5cm的较大结石。