急诊高龄患者腹腔镜胆囊切除术和开腹胆囊切除术的临床对比研究

目的探讨急诊高龄患者腹腔镜胆囊切除术和开腹胆囊切除术的临床治疗效果。方法 101例高龄急诊胆囊炎患者分别施行腹腔镜胆囊切除(LC)和开腹胆囊切除(OC)两种手术方法治疗,LC组53例,OC组48例,观察手术恢复及并发症等情况。结果在手术时间、术中出血量、术后疼痛、肠道功能恢复时间、住院时间、并发症发生率等方面,LC组明显优于OC组。结论高龄患者急性胆囊炎行LC并发症少,创伤小、痛苦小、恢复快,高龄患者急性胆囊炎行LC是安全可行的,并具有微创的优势。     

老年急性结石性胆囊炎急诊腹腔镜胆囊切除术的效果

目的探讨急诊腹腔镜胆囊切除术(LC)治疗老年急性结石性胆囊炎的效果。方法将接受急诊手术的80例老年急性结石性胆囊炎患者随机分为2组,每组40例。开腹组行开腹胆囊切除术(OC),腔镜组实施LC。比较2组的疗效。结果 2组手术时间差异无统计学意义(P0.05)。腔镜组术中出血量及术后肛门恢复排气时间、住院时间、并发症发生率均优于开腹组,差异均有统计学意义(P0.05)。结论急诊LC治疗老年急性结石性胆囊炎,创伤小、术后并发症少、患者术后恢复快,效果优于OC。     

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.     

老年患者腹腔镜胆囊切除术320例临床分析

目的:评价老年人行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性及可行性,探讨防范风险的应对措施。方法:比较、分析60岁以上老年人LC组(n=320)、开腹胆囊切除术(open cholecystectomy,OC)组(n=112)及非老年LC组(n=1 923)的临床资料。结果:老年人LC及OC组并存病显著高于非老年LC组(P<0.001)。LC组患者术后恢复良好,未发生严重并发症;老年LC与非老年LC在平均手术时间、平均术后住院天数及中转开腹率方面差异无统计学意义(P>0.05);而OC组平均手术时间、平均术后住院天数均较LC组显著延长(P<0.001),且并发症多(P<0.05)。结论:只要高度重视围手术期的处理,正确评估麻醉与手术的风险,把握手术时机及技巧,对老年患者施行LC不仅安全可行,而且更能凸显微创手术的优越性。     

老年患者急性胆囊炎行腹腔镜胆囊切除术与开腹式胆囊切除术的疗效比较

【摘要】〓目的〓比较腹腔镜胆囊切除术(LC)与开腹式胆囊切除术(OC)治疗老年患者急性胆囊炎的安全性和有效性。方法〓选择从2007年1月至2012年12月收治的年龄超过70岁急性胆囊炎患者76例,分别采用LC(34例)与OC(42例)治疗。观察两组的手术时间、术中失血、术后住院时间和术后并发症。结果〓两组患者手术均顺利完成胆囊切除术,且LC组无中转开腹的病例。LC组的手术时间为95.2±19.7 min,OC组的手术时间为86.8±21.2 min,两者差异无统计学意义;LC组术中失血>500 mL的有2例(5.9%),OC组术中失血>500 mL的有8例(19.0%)(P<0.05);LC组的术后住院时间明显少于OC组(P<0.01)。总共有24例患者在术后出现了并发症(31.6%),其中LC组的术后并发症明显少于OC组(P<0.05)。结论〓急性胆囊炎老年患者行腹腔镜胆囊切除术治疗能缩短术后住院时间和减少术后并发症发生率。     

腹腔镜胆囊切除术对老年胃肠功能恢复及并发症的影响

探讨腹腔镜胆囊切除术(LC)对老年患者胃肠道功能恢复的影响及并发症的发生情况。选取2012年1月—2015年12月手术治疗的270例胆囊切除术患者进行回顾性分析,其中140例患者采取LC、130例患者采取开腹手术,对比两组患者的胃肠道功能恢复、术后并发症的发生情况。LC组患者的肠鸣音恢复时间、排气时间、排便时间、腹胀、食欲差、恶心呕吐率均显著低于开腹组,差异有统计学意义(P<0.05);术前,两组血清胃动素、胃泌素、血管活性肠肽、生长抑素的水平差异均无统计学意义(P>0.05);术后48 h,LC组血清胃动素、胃泌素水平显著高于开腹组(P<0.05),LC组血管活性肠肽水平显著低于开腹组(P<0.05);LC组胆道损伤、出血、切口感染的发生率低于开腹组(P<0.05),胆瘘的发生率两组差异无统计学意义(P>0.05)。LC手术有利于老年患者胃肠道功能恢复。     

腹腔镜和开腹胆囊切除术治疗慢性胆囊炎急性发作疗效分析

目的探讨比较腹腔镜和开腹胆囊切除术治疗慢性胆囊炎急性发作的临床效果。方法回顾性分析45例腹腔镜胆囊切除术(LC组)与48例开腹胆囊切除术(OC组)患者的临床资料,对比2组患者术中情况、术后恢复情况及并发症比例。结果LC组的手术时间、术中出血量、切口长度均少于OC组,差异有统计学意义(P均<0.01),其中LC组有2例术中转开腹手术;LC组住院时间、住院费用、肛门排气时间、术后疼痛时间、下床活动时间均少于OC组,差异有统计学意义(P均<0.01);而LC组和OC组的术后并发症发生率分别为6.7%和8.3%,差异无统计学意义(P>0.05)。结论腹腔镜胆囊切除术治疗慢性胆囊炎急性发作,与开腹手术比较,具有创伤小、疼痛轻、恢复快、并发症少的特点,值得临床推广应用。     

老年人行腹腔镜胆囊切除术的特点

目的:探讨老年人腹腔镜胆囊切除术的特点。方法:分析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、住院天数、手术并发症、围手术期肺功能和血气分析变化,分别与中青年患者LC及老年患者剖腹胆囊切除术(OC)比较。结果:老年人LC平均手术时间为39min,手术中转率为5.6％,手术并发症占5.3％,均高于中青年LC患者,但明显低于OC的老年患者,且比较轻。但老年患者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:与OC比较,老年人LC仍是一种损伤小、安全可靠和恢复快的理想手术方法,但要针对老年患者的特点以及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。     

腹腔镜胆囊次全切除术在困难性胆囊切除中的应用分析

探讨腹腔镜胆囊次全切除术(LSC)在困难性胆囊切除中的应用价值。120例行困难性胆囊切除术的患者分别行LC(LC组)和LSC(LSC组)。两组患者均顺利完成手术,没有中转开腹及胆道损伤病例。LC组术中出血量明显多于LSC组(P<0.05);手术时间、引流管放置时间、住院时间比较,两组差异无统计学意义(P>0.05);LSC组患者术后生存质量明显优于LC组(P<0.05)。对于困难性胆囊切除患者,LSC安全、有效,能够有效避免LC中转开腹手术带来的不便。     

腹腔镜胆囊切除术与直视微创胆囊切除术治疗胆囊疾患比较分析

目的:比较分析腹腔镜胆囊切除术(LC)与直视微创胆囊切除术(MPC)治疗胆囊疾患的疗效。方法:2002年以来对228例患者分别行LC及MPC。对两组术后疗效、手术时间、住院时间、恢复工作时间、并发症等进行全面分析。结果:随访2~18个月,两组患者胆囊疾病引起的临床症状消失,效果满意。在手术时间安全性、术后并发症等方面,LC明显优于MPC(P<0.05)。结论:从手术安全性、减少术中、术后并发症,减轻患者痛苦,提高患者生存质量考虑,LC是治疗胆囊疾患的首选术式。     

Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis

Background

The purpose of the present study was to determine the prevalence of diabetes and its effect on surgical outcomes in patients undergoing emergent, in-patient cholecystectomy for acute cholecystitis. Some 8.3 % of the U.S. population has diabetes and this number is projected to rise to 21–33 % by 2050. Diabetes is considered to be associated with a higher incidence of acute cholecystitis; however, its impact on outcomes is unknown.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients with acute cholecystitis who underwent emergent in-patient cholecystectomy from 2004 to 2010. The study population was divided into two groups: diabetics and non-diabetics. Diabetics were further subdivided into those taking oral medication and those on insulin. Demographics, co-morbidities, and wound classification were compared with univariate analysis, and 30-day outcomes were compared with univariate and multivariate analyses.

Results

A total of 5,460 patients met the inclusion criteria. Of these 770 (14.10 %) had a diagnosis of diabetes. Mortality was higher for diabetics than for non-diabetics [4.4 vs 1.4 %, adjusted odds ratio (AOR) (95 % CI): 1.79 (1.09, 2.94), adj-p = 0.022]. Preoperative perforation rates were 25.1 and 13.0 %, respectively [AOR (95 % CI): 1.34 (1.09, 1.65), adj-p = 0.005]. The adjusted risk of cardiovascular events and renal failure was significantly higher for diabetics. Insulin treatment, but not oral medication, was associated with a significant increase in mortality, preoperative perforation, superficial surgical site infection, septic shock, cardiovascular incidents, and renal insufficiency.

Conclusions

In patients undergoing cholecystectomy for acute cholecystitis, diabetes increases the risk of mortality, cardiovascular events, and renal failure. Insulin-treated diabetics have more co-morbidities and poorer outcomes.     

逆行胆囊切除术在腹腔镜胆囊切除术中的应用

目的 探讨逆行胆囊切除术在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中的应用价值.方法 2008年10月～2012年8月,对67例LC因胆囊三角区解剖结构不清,不易分离者,从胆囊底部开始逆行切除胆囊术.结果 67例LC均获成功,无一例中转开腹.手术时间（73.7±9.6）min,术中出血（35.2±13.7）ml.67例随访12～18个月,平均14个月,恢复良好,无腹痛、腹胀及其他并发症发生.结论 在LC中对于Calot三角区解剖不清者采用逆行胆囊切除术安全可行.     

Cholecystectomy

Summary Laparoscopic cholecystectomy (LC), which results in less postoperative pain, disability, and scarring, has become an attractive alternative method of surgical management of the ambulatory patient with gallbladder disease. The best procedure for severely ill patients who are poor operative risks but require cholecystectomy, however, is unknown since the operative morbidity and mortality of LC in this group of patients has not been studied. All patients (177) undergoing cholecystectomy at one institution were evaluated. Based on their preoperative state of health as defined by a modified acute physiologic score (APS), patients were divided into two groups; one group was defined by an APS of less than 10, indicating they were in good health, and the other had an APS greater than or equal to 10, indicating that the group had multiple risk factors, predicting an increased postoperative morbidity and mortality. Selection for either procedure, LC or open cholecystectomy (OC), was made independently of the patient's preoperative status. Patients' past medical histories; demographic, physiologic, and laboratory data; and postoperative complications were evaluated. When all cholecystectomy patients were arranged into the respective risk groups, the age and severity of illness scores (APS) between LC and OC were not statistically different. Intraoperative and postoperative complications were not significantly different when patients undergoing LC were compared to patients undergoing OC. Laparoscopic cholecystectomy was associated with decreased hospitalization when compared to patients undergoing OC. The overall mortality of the patients undergoing OC was significantly greater than those undergoing LC. LC is an acceptable surgical alternative for high-risk patients requiring cholecystectomy.     

Needlescopic Cholecystectomy Versus Needlescope-assisted Laparoscopic Cholecystectomy

This clinical study was performed to compare the feasibility, safety, and best use of the needlescope and needlescopic instruments. Needlescopic cholecystectomy (NC) or needlescope-assisted cholecystectomy (NAC) was performed in 40 cases of gallbladder (GB) stone or polyp. There were 12 men and 28 women, with a mean age of 51.8 years (range, 27 to 79 y). The port sites consisted of three 2-mm ports at the right upper quadrant and one 12-mm port at the umbilicus. To evaluate the feasibility and safety of the needlescope, the time taken to perform each operative step was compared for NC and NAC. Operation time was divided into: (1) skin incision to insertion of the 4 ports; (2) insertion of the 4 ports to cannulation into the cystic duct; (3) time of intraoperative cholangiography (IOC); (4) skin incision to cutting of the cystic duct without IOC; (5) cutting the cystic duct to dissection of the GB; (6) dissection of the GB to removal of the GB; (7) removal of the GB to skin closure; and (8) total operation time. IOC was performed successfully in 10 cases of NC and 10 cases of NAC. Respective mean times of the 8 steps were 5.4 versus 5.3 minutes, 34.2 versus 32.2 minutes, 20.1 versus 18.4 minutes, 33.9 versus 31.3 minutes, 19.6 versus 18.9 minutes, 3.1 versus 2.9 minutes, 10.0 versus 10.2 minutes and 82.5 versus 77.8 minutes for NC versus NAC, respectively. There were no significant differences in any of the factors related to surgical procedures between the 2 groups, and there were no perioperative complications. The use of a needlescope and needlescopic instruments was feasible and safe for laparoscopic cholecystectomy in both surgical laparoscopic procedures for highly selected patients.     

Scarless Cholecystectomy: Laparoscopic Cholecystectomy with Abdominoplasty

Three patients presented to our hospital with abdominal wall laxity and symptomatic cholelithiasis. All of them wanted to undergo a cosmetic procedure (abdominoplasty) to reduce the abdominal wall laxity. They were also diagnosed to have cholelithiasis and had intermittent episodes of pain in the right upper quadrant of the abdomen. The ports for laparoscopic cholecystectomy were made in such a way that all the ports sites were removed in the skin flap that was excised during abdominoplasty, and there was no scar in the upper abdomen. The procedure was completed without leaving any telltale signs of laparoscopic cholecystectomy, and this led to a better cosmetic result from the patients’ point of view.