经脐单孔与三孔腹腔镜胆囊切除术的手术护理比较

目的:探讨经脐单孔与三孔腹腔镜胆囊切除术的临床护理方法。方法:选取腹腔镜胆囊切除术手术患者80例,其中经脐单孔组31例,三孔组49例,观察两组患者手术和护理效果。结果:单孔组患者手术时间明显长于三孔组,而疼痛指数、下床时间和平均住院时间均明显少于对照组,对比差异均具有统计学意义(P<0.05)。结论:经脐单孔腹腔镜胆囊切除术具有患者创伤小、术后恢复快、疼痛轻以及腹部无瘢痕等优点,值得进行进一步临床应用和研究。     

悬吊法经脐单孔腹腔镜胆囊切除术治疗胆囊息肉与胆囊结石的临床效果

目的:观察悬吊法经脐单孔腹腔镜胆囊切除术治疗胆囊息肉与胆囊结石的临床效果。方法:选取75例胆囊息肉与胆囊结石患者,按照随机数字表法分为对照组(n=37)和观察组(n=38)。对照组给予完全式经脐单孔腹腔镜胆囊切除术,观察组给予悬吊法经脐单孔腹腔镜胆囊切除术。比较两组手术及术后康复情况、并发症发生情况。结果:两组下床活动时间、住院时间相比,差异无统计学意义(P>0.05),观察组切口长度、手术用时较对照组短,术中出血量较对照组少,术后需应用镇痛剂患者比例较对照组低,差异均有统计学意义(P<0.05);观察组并发症发生率为7.89%,低于对照组的18.92%,差异无统计学意义(P>0.05)。结论:悬吊法经脐单孔腹腔镜胆囊切除术治疗胆囊息肉与胆囊结石的临床效果优于完全式经脐单孔腹腔镜胆囊切除术治疗效果。     

胆囊切除术给予经脐单孔腹腔镜比照常规腹腔镜术式的临床研究

目的研究胆囊切除术给予经脐单孔腹腔镜比照常规腹腔镜术式的临床效果。方法遴选82例胆囊疾病择期手术患者,随机分为对照组与研究组,各入组41例。前者行常规腹腔镜胆囊切除术,后者则接受经脐单孔腹腔镜胆囊切除术,以手术相关指标、脐部美观程度等为标准对两组手术效果予以评析。结果研究组的手术耗时明显更长(P0.05),术中失血量、切口疼痛评分、消化功能恢复、下床活动以及住院时间均明显更少(P0.05);研究组患者的瘢痕可见度评分明显更低(P0.05),脐窝外观满意度相比于对照组则明显更高(P0.05)。结论胆囊疾病施以经脐单孔腹腔镜胆囊切除术治疗具有出血少、恢复快的优势,可缩短疗程,且疤痕不明显,值得临床重视并加以推广应用。     

经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术临床疗效对比

目的：研究经脐单孔腹腔镜胆囊切除术的可行性以及安全性。方法随机选取2014年3月—2015年7月我院收治的实施胆囊切除术患者40例,将其随机均分为2组,其中对照组应用传统腹腔镜胆囊切除术开展治疗,观察组患者应用经脐单孔腹腔镜胆囊切除术开展治疗。对比分析2组患者的临床治疗效果。结果2组患者手术后都没有出现胆瘘、出血等并发症,2组患者手术时间、术中出血量、术后住院时间等指标比较没有明显差异（P>0.05）;术后肠功能恢复时间观察组明显短于对照组,差异具有统计学意义（P<0.05）;且观察组患者术后疼痛程度明显低于对照组,差异具有统计学意义（P<0.05）。结论在为患者开展胆囊切除术治疗的过程中,应用经脐单孔腹腔镜胆囊切除术能够有效缩短患者术后肠功能恢复时间,降低疼痛程度,并且安全可靠,值得在临床中推广应用。     

经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的比较研究

目的探讨经脐单孔法腹腔镜胆囊切除术的安全性和可行性。方法将80例需行腹腔镜胆囊切除患者随机单盲分为经脐单孔组和传统三孔法组（各40例）,比较两组手术中转率、手术时间、术中出血量、术后下床活动时间和术后住院时间等指标。采用视觉模拟评分法评估术后切口疼痛程度。结果两组患者术中出血量、切口疼痛程度、术后下床活动时间、术后进食时间、住院时间比较,差异均无统计学意义（P〉0．05）;经脐单孔组手术时间较传统三孔法组显著延长,分别为（62±15．5）min和（34±7．8）min（P〈0．001）。经脐单孔组术后腹部无可视瘢痕。结论经脐单孔法腹腔镜胆囊切除术安全可行,可满足患者术后无可视瘢痕的求。     

经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的疗效比较

目的探讨经脐单孔法腹腔镜胆囊切除术的安全性、可行性。方法随机将80例需行腹腔镜胆囊切除患者分为经脐单孔组和传统三孔法组各40例,比较两组手术中转率、手术时间、术中出血、术后切口疼痛、术后并发症、术后下床活动时间、肠功能恢复时间、术后住院时间。结果与传统三孔法相比,经脐单孔组除手术时间长外,其他临床观察指标两组间差异均无统计学意义（P〈0．05）。经脐单孔组术后患者对腹部无可视疤痕满意。结论经脐单孔法腹腔镜胆囊切除术是安全可行的,患者对无可视疤痕满意,有推广价值。     

腹腔镜经脐单孔胆囊切除术与传统胆囊切除术疗效对比

目的对临床应用腹腔镜经脐单孔行胆囊切除术与传统胆囊切除术的疗效进行对比分析.方法选取本院2009年2月至2011年8月间收治的42例胆囊良性疾病患者,将42例随机平均分为A、B两组,每组21例,A组患者给予腹腔镜经脐单孔胆囊切除术,给予B组患者传统腹腔镜胆囊切除术.对两组患者的手术时间、术中出血量、出院时间、胃肠功能恢复时间及并发症进行统计比较.结果两组患者手术均顺利完成,未产生一例并发症,A组患者在手术时间、住院时间及胃肠功能恢复三方面明显低于B组患者,差异明显;在并发症、术中出血量方面比较,两组患者无明显差异.结论腹腔镜经脐单孔胆囊切除术是一种安全的、可行的手术方式,且术后患者恢复快、瘢痕美容效果好,值得临床广泛推广使用.     

腹腔镜胆囊切除术的临床研究

目的:观察腹腔镜胆囊切除术治疗胆囊疾病的实际效果,探讨其临床应用价值。方法:选取2012年06月~2014年06月我院收治胆囊疾病患者50例,按1∶1比例将其分成实验组25例,对照组25例,对照组行传统腹腔镜胆囊切除术,实验组行经脐单孔腹腔镜胆囊切除术,比较胆囊治疗效果。结果:两组患者手术总有效率均为100.0%,比较两组术前准备时间、手术时间、术中出血量、术后拔管时间,差异均无统计意义(P0.05)。结论:传统腹腔镜胆囊切除术与经脐单孔腹腔镜胆囊切除术均具有较高的临床应用价值。     

经脐单孔与传统多孔腹腔镜胆囊切除术的对比研究

目的：探讨经脐单孔腹腔镜胆囊切除术的可行性及应用价值.方法：将120例胆囊结石、慢性胆囊炎、胆囊息肉患者行胆囊切除术,其中,经脐单孔腹腔镜胆囊切除术（TUSPLC）和传统多孔腹腔镜胆囊切除术（LC）各60例.对比其切口长度、术中出血量、手术时间、术后并发症、下床活动时间、止痛剂使用及住院时间.结果：在术中出血量、手术时间、术后并发症及术后住院时间方面,TUSPLC与LC组之间的差异无明显统计学意义（P＞0.05）;而切口长度及止痛剂使用次数方面TUSPLC组明显优于LC组（P＜0.05）.结论：经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全、有效,且更具微创性,美容效果更佳.临床应根据病情及患者需求选择其中更合适患者的手术方法.     

经脐单孔腹腔镜胆囊切除术的临床观察

目的探讨经脐单孔腹腔镜胆囊切除术治疗胆囊疾病的临床疗效。方法将我院需要进行胆囊切除术的胆囊炎患者28例随机分为治疗组和对照组,对照组应用传统腹腔镜胆囊切除术,治疗组应用经脐单孔腹腔镜切除术,比较分析2组患者手术情况和治疗效果。结果治疗组的术中出血量、住院天数、所花费用以及术后不良反应发生率等均低于对照组（P〈0.05）。结论应用经脐单孔腹腔镜胆囊切除术治疗胆囊疾病安全可靠,具有手术创伤小等优势,值得推广。     

腹腔镜胆囊切除术与开腹胆囊切除术的比较

目的：比较腹腔镜胆囊切除术（LC）与开腹胆囊切除术（OC）2种术式的优越性。方法：105例胆囊疾病患者分为两组,53例行LC,52例行OC,比较2种术式手术时间、术中出血量及术后抗生素应用时间、肛门排气时间、进食时间和住院时间。结果：LC组手术时间、术中出血量及术后抗生素应用时间、肛门排气时间、进食时间、住院时间等均较OC组患者减少或降低。结论：LC是一种安全可靠的手术方法,与传统的开腹手术相比具有创伤小、出血少、术野清楚、切口美观、术后恢复快、住院时间短等优点,将成为胆囊切除术的首选术式。     

Day-case laparoscopic cholecystectomy

Objectives:

To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure.

Methods:

All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology (ASA) grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed.

Results:

A total of 487 patients underwent laparoscopic cholecystectomy as a day case (ASA I=316, ASA II=171). Surgery was performed by high surgical trainees (HSTs) (n=417) and consultants (n=70) with conversion to open cholecystectomy in 4 patients. Twenty-two (5%) patients were admitted for overnight stay for different reasons, while 465 (95%) patients were discharged before 8 pm. Two patients (0.4 %) were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection (1%). A total of 443 patients were satisfied (97%), while 14 (3%) were unsatisfied. There was no mortality or intra-abdominal septic collection.

Conclusion:

Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management.The first laparoscopic cholecystectomy (LC) was performed by Muhe in 1985.1 Since then LC skills have progressively improved, and it has become the gold standard treatment for gallstone disease.2 It is most common to perform LC on an inpatient basis in the surgical ward or in the short stay unit with overnight admission. However, recent reports have demonstrated the safety and feasibility of day-case (DC) LC for selected patients.3-6 Advantages of DCLC over inpatient LC include early return to the community and work,3 lower cost,6 avoiding complications associated with hospital stay.6 However, this trend should not jeopardize the safety of the procedure because of early patient discharge. There are many concerns in treating surgeons mind embarking on DCLC. The serious complication of bleeding is usually detected at the time of surgery whereas bile duct injury, if not detected intra-operatively, manifests few days later.3 Other concerns are the management of post-operative pain, nausea, and vomiting. Experience, mostly from advanced centers did not find any difference between DCLC and overnight stay LC.3 However in an area like ours, where primary care facilities are not well integrated with hospitals, patients would have to return to the hospital if these postoperative problems could not be managed adequately at home. This study was undertaken to assess the experience with DCLC at this center with regard to feasibility, safety, postoperative management of pain, vomiting, and other complications, hospital re-admission rate, and patient satisfaction.     

腹腔镜胆囊切除术和开腹胆囊切除术后并发症 发生率的对比

目的 评价胆囊结石患者救治中施以开腹胆囊切除术或者腹腔镜胆囊切除术的临床意义.方法 选取胆囊结石患者118例,将其分为两组,其中常规组58例,选择开腹胆囊切除术对其施以治疗;治疗组60例,选择腹腔镜胆囊切除术对其施以治疗,观察两组手术指征和预后情况.结果 评定疗效,发现治疗组术后排气时长以及住院时长、出血量等指标优于常规组(P<0.05);治疗组60例患者中有3例(5.00%)出现并发症,常规组58例中有17例(29.31%),差异均有统计学意义(P<0.05).结论 开腹手术以及腹腔镜手术都可以充分切除患者胆囊组织,但腹腔镜手术在创伤性、安全性等方面都表现出优势,有助于促进患者术后康复,防止出现并发症,因此建议在胆囊结石患者救治中持续应用.     

Laser laparoscopic cholecystectomy.

Fifty consecutive patients underwent laser laparoscopic cholecystectomy (LLC) and four (8%) required conversion to open surgery. Among the 46, there was no mortality, no major morbidity, an average operating time of 101 minutes and hospital stay averaging 1.3 days. Patients experienced minimal pain and disability. Most were able to return to work within three days and to resume normal vigorous activity within seven days. The operation represents a major advance in the treatment of gallbladder disease.     

经脐单孔腹腔镜与传统腹腔镜胆囊切除术的对比研究

目的比较经脐单孔腹腔镜胆囊切除术(TUSPLC)与传统腹腔镜胆囊切除术(LC)的手术疗效,探讨经脐单孔腹腔镜胆囊切除术的安全性、可行性及特点。方法选择山西医科大学第一临床医学院普外科近期施行的经脐单孔腹腔镜胆囊切除术50例为单孔组,同一医师施行的传统腹腔镜胆囊切除术50例为对照组,比较两组的手术时间、术中出血量、术中有无副损伤、术后疼痛程度、术后肠功能恢复时间、术后并发症发生率及术后住院时间等指标。结果两组手术均顺利完成,单孔组与对照组平均手术时间分别为(65.20±28.75)min和(61.50±21.00)min,两组间差异无统计学意义(P>0.05);两组术中出血量、术后住院时间均无统计学差异(P>0.05);两组术后肠功能恢复时间分别为(22.76±4.22)h和(28.02±5.04)h,单孔组早于对照组(P<0.05)。单孔组术后疼痛程度明显低于对照组(P<0.05)。两组术中均无副损伤,术后均无出血、胆瘘等并发症发生。结论经脐单孔腹腔镜与传统腹腔镜胆囊切除术相比,具有术后疼痛轻、恢复快、腹部瘢痕不明显且隐避等优点,是安全、可行且更加微创的手术。     

腹腔镜胆囊切除术的临床研究

目的：探讨腹腔镜胆囊切除术的临床应用及并发症的发生与防治。方法：回顾性分析1026例腹腔胆囊切除术的临床资料。结果：腹腔镜胆囊切除术成功率97.4％，严重并发症率1.37％，其中胆管损伤0.49％，胆漏0.49％，出血0.39％。结论：腹腔镜胆囊切除术创伤小、恢复快、痛苦少。严格腹腔镜手术程序可降低严重并发症率。     

Jaundice post laparoscopic cholecystectomy

In just over 20 years, laparoscopic cholecystectomy has emerged as the standard therapy for cholelithiasis and is now being performed with increased safety. However an uncommon complication of this technique has been jaundice even in patients without iatrogenic bile duct injury. We report on two cases where this complication occurred and review the literature on this topic.