腹腔镜治疗老年人急性胆囊炎的体会

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2001年4月～2006年4月收治的164例LC老年病例分为早期组(85例,急性发作48h内)与延期组(79例,急性发作48h后)进行比较分析。同时,将老年人组(164例)与非老年人组(164例)进行比较分析。结果延期组较早期组LC手术时间和平均住院时间明显延长;老年人组较非老年人组LC手术时间延长,术中出血量及术后并发症明显增多。结论老年急性胆囊炎病人宜早期施行LC。老年女性常因妇科炎症且腹腔内粘连,使LC难度增加,术中、术后并发症的发生率增高。     

老年急性结石性胆囊炎不分离离断胆囊动脉主干左侧入路LC术的临床效果观察

目的探讨不分离离断胆囊动脉主干左侧入路LC术在治疗老年人急性结石性胆囊炎的安全性及疗效。方法回顾性分析我院2011.1~2015.9老年人急性结石性胆囊炎急诊行LC术共38例。其中采用不分离离断胆囊动脉主干左侧入路LC治疗17例老年人急性结石性胆囊炎记为实验组,21例行常规行LC术老年人急性结石性胆囊炎记为对照组。结果所有38例患者均顺利完成手术,未中转开腹。两组的手术时间,术后住院时间等方面无明显统计学差异(P0.05),术中出血量实验组明显低于对照组(P0.05)。结论采用不分离离断胆囊动脉主干左侧入路LC术治疗老年人急性结石性胆囊炎安全可靠,值得临床采用。     

老年人急性胆囊炎的腹腔镜手术治疗

目的:探讨老年人急性胆囊炎的临床特点,更好地把握腹腔镜胆囊切除(LC)术的时机和方法。方法:回顾分析32例老年人急性胆囊炎LC的临床资料,比较早期(急性发作48h内)LC及延期(急性发作48h后)LC的治疗结果。结果:早期及延期LC均获成功,患者全部治愈,未发生严重并发症;但延期LC的平均手术时间及术后平均住院日期较长。结论:老年人急性胆囊炎病情进展快,手术难度大、风险高;只要高度重视围手术期的处理,把握手术时机及技巧,早期LC是安全、可行的;除病情危重不能耐受手术者外,多数患者均应尽早施行LC。     

腹腔镜胆囊切除术在老年急性胆囊炎患者中的应用探讨

目的探讨腹腔镜胆囊切除术(LC)治疗老年人急性胆囊炎的可行性及临床疗效。方法回顾2008年1月—2011年2月收治的135例老年人(≥65岁)急性胆囊炎患者均实施腹腔镜胆囊切除术(LC)的临床资料,对其手术时间、中转开腹例数、术后并发症、住院天数等临床资料进行回顾性分析。结果 135例LC中,完成131例,成功率97.04%;中转开腹4例,中转开腹率2.96%。术后并发症5例(3.7%),包括胆瘘1例,皮下气肿1例,肺部感染2例,腹壁戳孔出血1例。无死亡病例,均治愈出院。结论老年急性胆囊炎患者行腹腔镜手术是安全可行的,应该成为首选的治疗方法。应重视围手术期处理,合理选择手术时机、术中细致操作、适时中转开腹可减少和避免术后并发症的发生。     

老年人急性胆囊炎急诊腹腔镜胆囊切除术时机的探讨

目的探讨老年人急性胆囊炎急诊腹腔镜胆囊切除术(LC)的可行性及时机。方法回顾分析86例65岁以上老年人急性胆囊炎急诊LC的临床资料。结果成功完成LC83例,中转开腹3例,中转率3.5%;无肝外胆管损伤等严重手术并发症发生。发病48h内行LC42例,全部完成LC,无手术并发症;发病48～72h行LC24例,中转开腹1例,术后并发毛细胆管漏1例,胸腹部皮下气肿1例;发病72h以上行LC20例,中转开腹2例,术后并发毛细胆管漏2例,一过性黄疸2例,全身皮下气肿2例,并发症发生率为30.0%。全组病人均痊愈出院。结论老年人急性胆囊炎经合理围手术期处理可安全完成LC,发病48h内行LC成功率高。     

老年人复杂的腹腔镜胆囊切除术

为探讨基层医院对老年人复杂的腹腔镜胆囊切除术 (LC)的可行性及处理方法 ,笔者回顾分析 3年间 2 58例老年人复杂的LC的临床资料。其中有并存症者 1 2 2例 ,腹部手术史 63例 ,肥胖者 (体重>75kg) 2 6例。急性胆囊炎 92例 ,慢性萎缩性胆囊炎 86例 ,胆囊周围广泛粘连 2 4例 ,胆囊三角冰冻粘连 1 8例。 2 52例LC获成功 ,6例中转开腹。术后 1例因迟发性胆漏行再次手术 ;术后 5例并发肺部感染 ,2例腹壁皮下气肿 ,均治愈。提示只要做好围手术期处理 ,并由具有丰富经验的腹腔镜手术医生施行手术 ,复杂的难度大的LC对于老年患者仍是安全可行的     

老年人结石性胆囊炎急性发作时腹腔镜手术61例体会

目的探讨老年结石性胆囊炎急性发作时腹腔镜胆囊切除术(LC)的时机和方法。方法总结分析了61例老年结石性胆囊炎急性发作时行LC病例的临床资料。比较发病72h以内(早期)和72h以外(延期)两组的治疗效果。结果全组病例无严重并发症发生，但延期组的平均手术时间、平均术后住院日和平均术后下床活动时间均较长，早期组LC全部成功，延期组中转手术2例(8．7％)。结论老年人结石性胆囊炎急性发作时早期行LC是安全的，延期施行LC要极为谨慎。     

急性结石性胆囊炎腹腔镜胆囊切除术对患者术后胃肠功能及C-反应蛋白的影响

目的观察急性结石性胆囊炎腹腔镜胆囊切除术(LC)对患者术后胃肠功能及C-反应蛋白(CRP)的影响。方法随机将76例急性结石性胆囊炎患者分为2组,每组38例。腹腔镜组实施LC,开腹组行开腹胆囊切除术(OC)。比较2组患者的手术时间、术后肛门恢复排气时间和术前及术第1、3天的CRP水平。结果 2组患者均顺利完成手术。腹腔镜组手术时间、术后肛门恢复排气时间均优于开腹组,差异有统计学意义(P0.05)。2组术前血清CRP水平差异无统计学意义(P0.05)。术后2组第1、3天血清CRP水平较术前均明显升高,其中开腹组升高幅度明显高于腹腔镜组,差异均有统计学意义。结果对急性结石性胆囊炎患者实施LC,创伤小、术后胃肠功能恢复快,而且安全性高。     

老年人急性胆囊炎的腹腔镜手术治疗

目的探讨老年人急性胆囊炎采用腹腔镜手术治疗的临床效果与应用价值。方法回顾性分析105例因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组(LC组)和剖腹胆囊切除术组(OC组)。结果两组患者手术时间、肠功能恢复时间及住院天数差异均有统计学意义(P<0.01),LC组优于OC组;术中出血、腹腔引流量和术后并发症两组差异无统计学意义(P>0.05)。结论老年急性胆囊炎患者行腹腔镜治疗是安全可行的。     

老年人腹腔镜胆囊切除术的特点

目的 探索老年人LC的特点及围手术期处理。方法 回顾性分析了266例老年人(≥65岁)行腹腔镜胆囊切除术(LC)的手术时间、中转剖腹手术例数、住院天、手术并发症、围手术期肺功能和血气分析变化,分别与中青年病人LC及老年病人剖腹胆囊切除术(OC)比较。结果 老年人LC平均手术时间(39分)、手术中转率(5.6％)、手术并发症(5.3％)均高于中青年LC患者,而明显低于OC的老年病人,且并发症较轻。但老年人LC后的肺功能减退(10.2％)和高碳酸血症(20.3％)明显多于OC,多数可在术后短时间内恢复。结论 老年人LC仍不失为一种损伤小、安全可靠和恢复快的理想手术方法,但要针对老年病人的特点以及LC可能引起的肺功能下降和高碳酸血症,做好术前处理、术中及术后监测和并发症的预防。     

老年人胆囊切除术的围手术期处理

目的探讨老年人胆囊切除术的围手术期处理策略。方法回顾性分析我院2007年1月至2013年12月经手术治疗的386例年龄大于70岁的胆囊切除患者的病例资料。结果腹腔镜胆囊切除295例,小切口开腹胆囊切除79例,11例中转开腹胆囊切除,胆囊造瘘1例,25.6%的病人(99例)存在不同类型的并存病,手术并发症发生率7.3%(28例),均治愈,死亡1例。结论老年人胆囊切除手术应加强围手术期的处理合理选择手术时机和手术方式是关键。     

老年人胆道疾病的外科治疗

目的　探讨 6 0岁以上老年人胆道疾病的外科处理方法及其效果。方法　回顾性总结了 1992年 1月～ 2 0 0 0年 1月间12 7例老年胆道疾病的外科治疗情况。结果　本组胆囊切除和 /或胆总管探查术 78例 ,胆囊造瘘术 12例 ,各类型胆肠吻合术 2 7例 ,Oddis括约肌切开成形术 3例 ,PTCD4例 ,剖腹探查、组织活检术 3例 ,本组中联合左肝外叶切除 11例。术后总病死率 5 .5 % ,急诊手术病死率 12 .8% ,择期手术的占 2 .3% ,x2 =3.92 37,P<0 .0 5。结论　对老年胆道疾病患者 ,尤其存在合并症者 ,应积极作好围手术期处理 ,在适当的时机选择适合老年病人特点的手术方式 ,以期最大限度地减少术后并发症 ,降低病死率。     

Outpatient Laparoscopic Cholecystectomy

Outpatient Laparoscopic Cholecystectomy was attempted in 98 patients selected from 266 patients presenting for elective cholecystectomy (37%). Two patients required admission following conversion to “open” Cholecystectomy, one patient was admitted for observation because of a technically difficult Laparoscopic Cholecystectomy and 16 patients were admitted because of refractory nausea and vomiting in the early post-operative period. Seventy-nine patients (81%) were able to be discharged home within 4 to 6 hours of surgery, with only one patient requiring readmission to hospital because of the onset of nausea and vomiting. There were no post-operative complications attributable to the outpatient experience. We believe this approach to elective gallbladder pathology can be safely accomplished in selected patients and will be increasingly utilized in the future.     

SURGERY FOR GALLSTONES IN THE ELDERLY

In a consecutive series of 349 patients undergoing surgery for gallstones. 66 patients (19%) were aged over 65 years. Within this group of elderly patients. 51 underwent laparoscopic cholecystectoiny which was successful in 84% of cases. The most frequent cause for conversion to open surgery was the presence of dense pericystic adhesions. Fifteen patients (23%) underwent elective open surgery. The principal reason was co-existent duct stones. There was no operative mortality and procedure related morbidity in the elderly following laparoscopic or open surgery was similar. Laparoscopic cholecystectoiny can be safely and effectively performed in the majority of elderly patients. offering thein the perceived advantages of this technique. However. the presence of duct stones in 18% of cases necessitates careful evaluation of these patients pre-operatively.     

腹腔镜胆囊切除术后胆漏的处理

目的探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC）术后胆漏的各种处理方式。方法回顾性分析我院2000年2月-2005年5月施行的LC3868例。结果术后发生胆漏22例,胆漏发生率为0.56%。所有胆漏患者经保守治疗、再次腹腔镜探查置管、内镜治疗和腹腔引流管充分引流后造影拔管治疗。结论非主胆道损伤所引起的胆漏多可经非开腹手术治疗而治愈。     

腹腔镜胆囊切除术中转开腹17例分析

１９９２年１０月￣１９９７年１０月共行腹腔镜胆囊切除术１０８２例，其中术中转开腹１７例。中转开腹率１．５７％。文章分析了导致中转开腹的两类原因：一类是疾病原因，这类中转开腹很难避免，故要求术前正确评价手术难易程度，掌握好适应证；另一类是技术原因，可以通过提高手术拔巧来逐步减少。中转开腹是保证病人安全和手术质量的重要措施。     

腹腔镜胆囊切除术后胆漏的原因及处理

目的：探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC)术后胆漏的诊治预防措施。方法：对本1991年3月－2001年5月9267例LC术后发生胆漏31例（0．33％）的原因进行回顾和分析。结果：全部治愈,18例经过非手术治疗,占58％,13例行再次腹腔镜探查或开腹探查手术,占42％。结论：严格掌握腹腔镜胆囊切除手术适应证,沿胆囊壶腹向下分离,仔细辨别Calot三角剖结构,采取顺行和（或）逆行结合、适时把握中转开腹手术的时机是预防胆漏等并发症的关键。     

急性胆囊炎腹腔镜切除术式选择

目的 :探讨急性胆囊炎行腹腔镜胆囊切除术的安全性。方法 :腹腔镜对急性胆囊炎的治疗分别选择 :胆囊大部分切除、胆囊前壁切除、胆囊完整切除三种术式。结果 :顺利完成腹腔镜胆囊切除 2 32例 ,中转手术 4例。全组无死亡病例 ,无胆道损伤、大出血等严重并发症。结论 :随着腹腔镜胆囊切除术经验积累和器械完善 ,急性化脓、坏死性胆囊炎甚至胆囊穿孔已不再是腹腔镜胆囊切除的禁忌证 ,均可在急性炎症期完成腹腔镜胆囊切除术。     

Use of endoscopic and surgical methods in the treatment of patients with acute cholecystitis

Laparoscopic gallbladder drainage (LGBD) was undertaken to arrest acute inflammation in 121 patients suffering from acute cholecystitis and serious concomitant diseases. Their ages ranged from 30 to 89 years. Cholecystectomy was carried out in 78 patients after complete abatement of the inflammatory process. When the risk of a radical operation was very high treatment was restricted to cleansing of the gallbladder cavity (CGBC). In 9 patients stones were removed from the gallbladder through a cholecystostoma, formed during LGBD, using a choledochoscope. Cleansing cholecystostomy under local anesthesia was conducted in 19 cases. Fifteen patients who were treated by CGBC had choledocholithiasis; they were subjected to endoscopic papillosphincterotomy. The death rate was 1.6%.     

Laparoscopic cholecystectomy in Leicester: an audit of 555 patients.

Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though there have been no published randomised controlled trials to demonstrate the safety of this approach. We present an audit of 555 patients offered laparoscopic cholecystectomy. In all, 54 patients (9.7%) were converted to an open procedure. Peroperative cholangiography (POC) was attempted in 190 cases (34.2%) and achieved in 141 (25.4%). Major complications occurred in 26 cases (4.7%) including 5 (0.9%) deaths, two of whom had major pre-existing morbidity. There was one common bile duct (CBD) injury (0.18%). There were 30 patients (5.4%) found to have CBD stones, 27 of which were cleared at ERCP, and three converted to open exploration. Cholecystectomy by any route is a major operation and we conclude that careful case selection remains imperative. However, morbidity is favourable compared with open cholecystectomy, and comparable with other reports using the laparoscopic technique. Our experience of CBD injury (0.18%) is also acceptable compared with the risk of injury during open cholecystectomy. There were 312 patients (56.2%) who did not undergo perioperative CBD imaging with ERCP or POC and three of these developed early symptomatic retained stones. This group requires further follow-up.