腹腔镜胆囊切除术适应证的探讨

首例腹腔镜胆囊切除术(Laparoscoic cholecystectomy简称LC)是1987年法国医生Mouret完成的。由于该法具有创伤小，术后病人恢复快等优点，优于传统的剖腹手术，故在法国、英国、美国等国家已广泛应用，国内也有报道。LC的手术适应证也在不断扩大。     

腹腔镜胆囊切除术适应证

腹腔镜胆囊切除术适应证张豫峰，王秋生，邓绍庆（北京医科大学第三临床医学院北京１０００８３）腹腔镜胆囊切除术（ＬａｐａｒｏｓｃｏｐｉｃＣｈｏｌｅｃｙｓｔｅｃｔｏｍｙ，ＬＣ），自１９８７年临床应用成功以来，在较短的时间内已发展成为一种成熟定型的手术，可是...     

腹腔镜胆囊切除术适应证的选择

腹腔镜胆囊切除术适应证的选择徐义仁（武警安徽总队医院合肥２３００４１）我院１９９２年１０月至１９９４年１２月完成腹腔镜手术３１２４例，除１８例系其它腹部和妇科手术外，ＬＣ３１０６例，主要并发症（胆管损伤、胆瘘和出血）６例（０．１９％），无死亡。现就Ｌ...     

腹腔镜胆囊逆行切除术探讨

目的　防止腹腔镜胆囊切除时胆道损伤 ,并使腹腔镜胆囊切除术的适应证放宽。方法　通过对 2 7例腹腔镜胆囊逆行切除病例资料的回顾及随访结果 ,对术中胆囊动脉的处理方法、胆囊管的处理方法、术中及术后并发症的发生进行了分析及总结。结果　 2 7例腹腔镜胆囊逆行切除术中 ,2 5例术中基本顺利 ,2例因胆囊动脉出血而中转开腹。结论　腹腔镜胆囊逆行切除术对Calot三角区水肿、粘连、解剖结构不清确有保证手术安全的作用 ,同时使腹腔镜手术的适应证得以适当放宽     

电视腹腔镜胆囊切除术安全性探讨

电视腹腔镜胆囊切除术（ＬＣ）作为一项全新的技术因其微创性已在全世界范围内广泛开展,但其安全性的评估还有待实践进一步检验［１］。尽管Ｌａｒｓｏｎ［４］报道一组１９８３例ＬＣ病例并发症仅为０．０８％,但朱炳光等［２］报道ＬＣ１１６５４例发生严重并发症１１...     

腹腔镜胆囊切除术引流的探讨

腹腔镜胆囊切除术 ( L C)由于其创伤小、痛苦小、住院时间短而成为胆囊切除的主要方法 ,腹腔引流必然会导致住院时间延长 ,早期活动受限。现就这一问题结合本院的 2 3例进行探讨分析。1　临床资料本组病例 2 3例 ,男 8例 ,女 15例 ,年龄 31～ 71岁 ,平均 4 8.2岁。其中急性胆囊炎胆囊结石 5例、胆囊积脓 2例、慢性胆囊炎胆囊结石 16例 ,合并肝硬化者3例 ,术中见 Calot三角解剖不清者 13例 ,胆囊床和Calot三角区渗血 6例 ,胆囊床部分粘膜残留 1例 ,胆囊管破裂 1例 ,2 3例中有 16例胆囊破裂。2　方法和结果方法 :本组病例均采用多孔乳胶管被…     

单切口腹腔镜胆囊切除术与腹腔镜胆囊切除术的病例对照研究

目的回顾性分析单切口腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（LC）的优劣性。方法19例SILC及46例LC患者的临床资料,比较两者的手术时间、术中出血量、术后并发症、中转率、术后疼痛、住院时间、切口长度的差异。结果SILC手术耗时（49．00±8．34）min长于LC（P=0．000）。术中出血量差异无统计学意义。两组均无中转、术后无并发症;SILC与Lc术后患者第一天疼痛评分、术后第三天疼痛评分、总疼痛天数差异均无统计学意义。两者住院时间差异无统计学意义。SILC切口长度（22．5±3．5）mm短于LC切口长度（P=0．000）。结论SILC总切口长度短于LC总切口长度,切口效果更美观。SILC能安全地用于单纯胆囊结石、胆囊息肉。同时对于没有严重合并症和腹部手术史的胆囊疾病患者SILC也是一种理想的手术选择。     

腹腔镜胆囊切除术的手术适应证问题

腹腔镜胆囊切除术的手术适应证问题黄志强（北京解放军总医院北京１００８５３）腹腔镜胆囊切除术自１９８７年开始成功地使用以来，此一治疗方式以空前的速度在世界范围内展开，这自然是此技术符合当前的最小创伤的外科手术的总趋向，但亦无可否认也是因外科医生受到病人...     

急性胆囊炎腹腔镜胆囊切除术适应证与术式研究

目的探讨急性胆囊炎腹腔镜胆囊切除术的适应证及方法. 方法回顾分析78例急性胆囊炎的腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)的临床资料.65例胆囊颈部结石嵌顿;顺行切除47例,逆行切除19例,大部切除12例. 结果 74例手术成功,4例中转开腹;61例放置引流管,手术后24～48 h拔除.术后平均住院4.8 d.1例灼伤肝总管致术后胆漏,经开腹置T管6个月治愈.无其它严重并发症. 结论除少数病例(如Mirizzi综合征Ⅲ型及Ⅳ型、胆囊埋入或大部埋入肝内者及怀疑并发胆囊癌者)外,急性胆囊炎病人在发病后48 h内,应用顺行、逆行或大部切除等方法,可以安全施行LC.     

A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy

Background  Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for carefully selected patients. Methods  A systematic review of Cochrane, Embase, and Medline using the keywords “ambulatory,” “laparoscopic,” and “cholecystectomy” was performed. Postoperative complications leading to admissions and readmissions were compared between day care and inpatient laparoscopic cholecystectomy groups. Postoperative quality of life, patient satisfaction, and cost effectiveness also were analyzed. Results  The search process identified seven clinical trials suitable for meta-analysis. These trials, consisting of 598 patients, compared day care and inpatient procedures. The unplanned admission rate in the ambulatory group was comparable with the prolonged hospitalization of inpatients (odds ratio [OR], 1.979; 95% confidence interval [CI], 0.846–4.628). There was no significant difference between the readmission rates of the two groups (OR, 0.964; 95% CI, 0.318–2.922). The quality-of-life indicators were similar for the ambulatory and overnight-stay patients (p = 0.195). The cost effectiveness was better for the day care procedures because of the shorter mean hospital stay. Conclusion  Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level of patient satisfaction.     

Cost-effectiveness of laparoscopic cholecystectomy

This study retrospectively evaluated the cost-effectiveness of laparoscopic cholecystectomy compared to open cholecystectomy in a single university-affiliated community hospital. The medical records of all patients that underwent laparoscopic cholecystectomy during 1990 and open cholecystectomy during 1989 in one hospital were reviewed. Hospital stay, hospital charges, surgeons' and anesthesiologists' fees were determined. Fifty patients from each group were contacted to determine recovery time to full activity after surgery. Those having common duct exploration and those converted to open cholecystectomy after an attempted laparoscopic cholecystectomy (n=8) were excluded. A summary of results is included below (Table 1).In our early experience with laparoscopic cholecystectomy we found that the total charges for laparoscopic cholecystectomy were more than for open cholecystectomy when one recognizes the 1-year difference in patient accrual between the two groups. Time to full recovery was markedly reduced in patients undergoing laparoscopic cholecystectomy compared to those having an open procedure. Despite the overall increased total charge with laparoscopic cholecystectomy, the shorter recovery period allowing the patients an earlier return to full preoperative activities contributes to its cost-effectiveness when compared to open cholecystectomy. Further experience with laparoscopic cholecystectomy and refinements in management of these patients should allow for further reductions in charges for this procedure.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 18–19 April 1994The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the DOD, the USAF, or of other federal agencies. The authors above are responsible for the contents of the paper.     

低压气腹腹腔镜胆囊切除术在高危胆囊结石患者中的应用

目的 探讨高危人群低压气腹下腹腔镜胆囊切除术的安全性。方法 回顾分析近3年来对72例高危人群低压气腹下用腹腔镜行胆囊切除术的临床资料。结果 72例中,因术中出血中转开腹1例,因粘连分离困难开腹2例,余均顺利完成手术,无手术并发症,无死亡。结论 高危人群合并胆囊结石选用腹腔镜行胆囊切除术是安全、有效、可靠的方法,术后并发症少。低压缓慢造气腹是行腹腔镜胆囊切除术成功的关键。     

腹腔镜胆囊切除4033例临床分析

本文报道腹腔镜胆囊切除４０３３例。腹部手术史６２８例，占１５．５７％，伴随疾病１１７５例，占２９．１３％。择期手术３７４０例，占９２．７３％，急诊手术２９３例，占７．２６％。术后发生各种并发症４１例，占１．０１％。死亡１例，中转手术４９例，临床治愈３９８３例，占９８．７６％。重点介绍了经胆囊颈后壁径路解剖Ｃａｌｏｔ三角的方法及优点。     

腹腔镜胆囊切除术治疗复杂性胆囊结石902例分析

目的:总结腹腔镜胆囊切除术治疗复杂性胆囊结石的疗效及手术操作技巧。方法:对比分析单纯性胆囊结石组和复杂性胆囊结石组的手术时间、术后住院时间、中转开腹手术率及并发症发生率。结果:单纯组和复杂组手术时间分别为30.16±17.20min和41.83±26.76min(P<0.01),术后住院时间分别为3.56±1.14d和3.74±1.23d(P>0.05),中转开腹手术率分别为0.21％和2.44％(P<0.01),并发症发生率分别为0.29％和1.66％(P<0.01)。单纯组98％的患者和复杂组95％以上的患者均能经LC治愈。结论:只要正确评估手术难度,腹腔镜外科医师技术娴熟,便能明显降低中转开腹手术率及并发症发生率,获得与单纯组同样的疗效。     

Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy

Background and aims Laparoscopic surgery has become the treatment of choice for cholecystectomy. Many studies showed that while this approach benefits the patient, the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence. Robots have the potential to overcome these problems. To evaluate the efficiency and feasibility of robotically assisted surgery (RAC), we designed a prospective study to compare it with standard laparoscopic cholecystectomy (SLC).Materials and methods Between 2001 and 2003, 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system. The feasibility, safety, and possible advantages were evaluated. To assess the efficacy, the total time in the operating room was divided into preoperative, operative, and postoperative time frames.Results For RAC in comparison with SLC, the preoperative phase including equipment setup was significantly longer. In the intraoperative phase, the cut-closure time and camera and trocar insertion times were significantly longer. It is interesting to note that the net dissection time for the cystic artery, duct, and the gall bladder was not different from SLC.Conclusions The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity. There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore, presents no benefit in using the robot in laparoscopic cholecystectomy.     

腹腔镜胆囊切除术中粗大胆囊管处理体会

目的　探讨腹腔镜胆囊切除术中粗大胆囊管的处理方法。　方法　回顾分析 1995年 5月～ 2 0 0 1年 12月我院 10 5 2例LC中 2 4例粗大胆囊管的临床资料 ,其中胆囊管 (0 4～ 0 6 )cm 12例 ,(0 6～0 8)cm 8例 ,(0 8～ 1 0 )cm 2例 ,>1cm 2例。分别采用二夹法 (10例 ) ,三夹法 (5例 ) ,梯形钳夹法 (6例 ) ,旋转钳夹法 (3例 )处理。　结果　 2 1例顺利完成LC ,3例因术中出血中转开腹。全组无胆漏、膈下积液发生。　结论　腹腔镜胆囊切除术中粗大胆囊管采取不同方法处理可顺利完成LC。     

腹腔镜胆囊切除术中胆道造影的应用价值

目的 评价术中胆道造影技术在腹腔镜胆囊切除术中的应用价值。方法 腹腔镜胆囊切除术中经胆囊管插管行胆道造影共1226例,其中1180例造影成功,成功率为95．5％。结果 术中造影共发现胆总管结石78例,胆管损伤7例,副肝管2例。结论 腹腔镜胆囊切除术中胆道造影简单易行,显影清楚,能提高手术质量,降低胆管损伤发生率。     

腹腔镜胆囊切除术中出血的原因分析与处理

目的探讨腹腔镜胆囊切除术(LC)术中出血的原因与处理措施。方法总结24例LC术中出血患者的临床资料,分析LC术中出血的原因与处理方法。结果LC术中出血的原因与术者的技术水平以及患者的解剖类型和胆囊炎严重程度有关,24例经电凝、重新施夹、压迫、缝扎等方法成功止血。结论LC术中出血需要及时有效的处理,可避免严重后果。     

腹腔镜下胆囊切除术在改善免疫功能和术后恢复中的价值研究

目的：研究腹腔镜下胆囊切除术在改善免疫功能和术后恢复中的价值。方法将接受胆囊切除术的患者纳入研究,随机分为给予腹腔镜手术的观察组和给予开腹手术的对照组,观察术中免疫功能和术后恢复情况,并分析两者的相关性。结果（1）观察组患者的术中IgG、IgM、IgA水平高于对照组（P＜0.05）,术后肛门排气时间、流质饮食时间、卧床时间以及住院总时间均低于对照组（P＜0.05）;（2）术后肛门排气时间、流质饮食时间、卧床时间以及住院总时间均与IgG、IgM、IgA水平呈负相关（P＜0.05）。结论腹腔镜下胆囊切除术有助于改善免疫功能、促进术后恢复,具有积极的临床价值。