免气腹三孔法腹腔镜胆囊切除术的探讨

目的:探讨硬膜外阻滞下免气腹三孔法腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)在临床上的应用。方法:回顾性分析2002年4月~2006年10月386例胆囊结石或胆囊息肉患者在连续硬膜外阻滞下施行免气腹腹腔镜胆囊切除术的临床资料。结果:386例中除5例中转手术外,381例均顺利完成LC。术后无酸中毒、肩痛、心肺功能的进一步损伤及其他并发症发生。结论:免气腹三孔法LC非常适用于心肺功能差、肾功能不全及肝硬化等不能耐受气腹的老年患者,手术费用降低,并发症发生率下降。     

免气腹与气腹腹腔镜胆囊切除术的临床对比分析

目的:探讨免气腹腹腔镜胆囊切除术(gasless laparoscopic cholecystectomy,GLLC)的应用、优点及可行性。方法:选取2009年3月至2012年6月60例GLLC(免气腹组)及60例气腹腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC,气腹组)患者进行回顾性对比分析,对比两组手术时间、术中出血量、术后肠道功能恢复时间、住院时间、术前与术后血气分析、术后并发症等指标。结果:两组均成功完成手术,无一例中转开腹,切口均甲级愈合。两组患者手术时间、术中出血量、肛门排气时间、住院时间差异均无统计学意义(P>0.05)。术前DBP、PaO2、PaCO2、SpO2、PETCO2、pH两组相比差异均无统计学意义(P>0.05),术前SBP、MAP两组相比差异有统计学意义(P<0.05)。两组患者术后PaCO2、SpO2、pH值差异均无统计学意义(P>0.05),DBP、SBP、MAP、PaO2、PETCO2差异有统计学意义(P<0.05)。结论:免气腹腹腔镜手术具有安全、微创、术后康复快等优点,无CO2气腹相关并发症发生,对人体血流动力影响小,具有较好的临床应用价值。     

免气腹腹腔镜胆囊切除术的临床应用价值

目的探讨免气腹腹腔镜胆囊切除术的临床应用价值。方法回顾性分析2006年3月至2008年3月间38例免气腹腹腔镜胆囊切除术患者的临床资料。结果38例患者均顺利完成手术．手术成功率100％,无血管损伤、脏器穿孔、胆道损伤、胆漏或者中转开腹等并发症发生。8例患者术后出现右肩背酸痛,对症治疗好转。结论免气腹腹腔镜胆囊切除术扩大了腹腔镜胆囊手术的范围,避免了气腹对人体的影响,尤其是针对心肺功能不全的老年患者,有不可取代的作用,是值得推广的。建立手术空间牵拉膈肌可能是造成腹腔镜术后肩背疼痛的重要原因。     

免气腹及气腹腹腔镜胆囊切除术的对比研究

目的探讨免气腹腹腔镜胆囊切除术(gsaless laparoscopic cholecystectomy,GLC)的临床应用价值及其对机体的应激反应和肩部疼痛的影响。方法 2010年3月至2014年1月为46例患者行GLC,,同期为48例患者行传统LC。观察两组在手术时间、术后即时动脉血气分析、术后第一天血白细胞、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)、白介素6(IL-6)、前列腺素E2(PGE2)的同异和术后患者肩部疼痛的程度。结果 GLC组和传统LC组在手术时间、术后即时动脉血气分析、术后第一天血白细胞(WBC)、IL-6和术后6 h患者肩部疼痛2组比较差异有统计学意义。而在术后第一天血CRP、ACTH、PGE2和术后24 h肩部疼痛评分方面2组比较差异无统计学意义。结论 GLC是一种安全、有效的手术方式,它可避免气腹手术的CO2相关并发症,拓宽了腹腔镜手术的应用范围,具有在临床推广使用的价值。     

硬膜外麻醉下免气腹腹腔镜胆囊切除术的临床对照研究

目的探讨硬膜外麻醉下免气腹腹腔镜胆囊切除术(LC)的临床治疗效果。方法选取2012年3月至2014年6月在我院治疗的胆囊结石患者,将患者随机分为研究组(给予硬膜外麻醉免气腹LC)和对照组(给予全麻有气腹LC),观察两组患者手术中出血量、手术时间、术前麻醉时间、肛门恢复排气时间、切口感染、住院天数、住院费用等指标。结果研究组术前麻醉时间为(4.44±0.45)min,长于对照组的(3.42±0.72)min,而排气时间为(20.35±7.02)h,短于对照组的(31.52±6.38)h,差异有统计学意义(P0.05);研究组术后下床时间和住院费用分别为(18.12±7.05)h和(8 135.45±1 159.48)元,均优于对照组的(23.47±6.82)h和(9 563.64±1 532.04)元,差异有统计学意义(P0.05);研究组术后并发症发生率为3.28%,而对照组的5.29%,两组差异无统计学意义(P0.05)。结论硬膜外麻醉下免气腹LC,相对于全麻下LC,手术组患者创伤相当,免去了全麻及其苏醒过程,恢复快,费用明显减少,经济效益明显,是一种值得推广的术式。     

免气腹腹腔镜胆囊切除36例临床应用体会

目的探讨免气腹腹腔镜胆囊切除术的临床应用价值。方法回顾性分析2010年3月～2012年3月我院36例免气腹腹腔镜胆囊切除术患者的临床资料。结果全部患者均顺利完成手术。无血管损伤、脏器穿孔、胆道损伤、胆漏或者中转开腹等并发症发生。结论免气腹腹腔镜胆囊切除术是一种安全、有效的手术方式,是合并心肺功能不全等疾病的老年患者较理想的术式选择。     

老年人免气腹腹腔镜胆囊切除术的应用体会

目的 探讨免气腹腹腔镜胆囊切除术治疗老年人胆囊结石的价值.方法 回顾性分析2007年11月至2009年4月间52例老年胆囊结石患者施行免气腹腹腔镜胆囊切除术的临床资料.结果 52例顺利完成免气腹腹腔镜胆囊切除术,无中转开腹.手术时间30~120 min,平均55.1 min.置腹腔引流管8例.2例发生肩痛.术后无出血、胆管损伤、心肺功能障碍的进一步加重.结论 加强围手术期处理,控制好合并症,老年患者行免气腹腹腔镜胆囊切除术是安全可行的,是较好的手术治疗方案.     

免气腹腹腔镜胆囊切除术在老年患者中的应用体会

目的：总结免气腹腹腔镜胆囊切除术（gasless laparoscopic cholecystectomy, GLC）在老年患者中的应用价值及临床体会。方法：回顾分析2013年1月至2013年7月为12例老年慢性胆囊炎、胆囊结石或胆囊息肉患者行GLC的临床资料,记录手术时间、麻醉时间、术后恢复情况、并发症、住院时间等指标。结果：手术均获成功,无一例中转开腹。手术时间平均（46．67±7．49）min,麻醉时间平均（72．08±8．65）min,术后首次肛门排气时间平均（26．55±16．01）h,术后首次肛门排便时间平均（51．64±16．49）h。均无胆漏、心肺功能障碍加重、颈肩痛及术后恶心呕吐。平均住院（5．92±1．24）d,患者均治愈出院。术后随访1～6个月,均无胆管狭窄、残余结石等并发症发生。结论：GLC避免了CO2气腹对呼吸系统、循环系统的影响,提高了手术安全性,对于合并心肺功能障碍的老年患者是较理想的选择。     

单孔双视免气腹腹腔镜胆囊切除术的临床应用体会

目的:探讨单孔双视免气腹腹腔镜胆囊切除术的临床疗效。方法:2013年11月至2016年5月为167例胆囊良性病变患者行单孔双视免气腹腹腔镜胆囊切除术,剑突下偏右做2.0~2.5 cm切口,用吸切剥离器解剖出胆囊管及胆囊动脉,夹闭后切断,左手指沿胆囊与肝脏间隙轻柔剥离,右手提起胆囊管轻轻旋转,双手配合完成胆囊切除术。合并胆总管结石的患者,切开胆总管,采用胆道镜取石,其中11例行胆总管一期缝合,5例放置T管。结果:167例手术均获成功,5例合并胆总管结石患者因操作部位深且粘连炎症重,适当扩大切口至3.5 cm。手术时间平均(40.0±8.9)min;术中出血量平均(20.5±4.6)ml。术后切口疼痛轻微,无出血、胆漏等并发症发生。3例术后胆囊窝积液经保守治疗后痊愈。单纯胆囊切除术后3~4 d出院;行胆总管取石的患者术后7 d出院,3个月后门诊常规行胆道镜检查,无残留结石后拔除T管。167例患者术后随访8~12个月,均恢复良好。结论:单孔双视免气腹腹腔镜胆囊切除术适应证广、安全、可行,疗效满意。     

免气腹腹腔镜胆囊切除术对呼吸循环及术后并发症的影响

目的 研究免气腹腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对呼吸循环功能及术后并发症的影响.方法 60例择期LC患者,ASA Ⅰ或Ⅱ级,用随机数字表法分为A、B两组,每组30例,A组为免气腹组,B组为气腹组.全麻后,潮气量均为10 ml/kg,呼吸频率(RR)均为12次/分,吸呼...     

悬吊式免气腹三孔腹腔镜胆囊切除术的应用体会

目的:探讨悬吊式免气腹三孔腹腔镜胆囊切除术的可行性及临床应用价值。方法:回顾分析2014年9月至2015年12月为26例患者(高龄或合并心肺功能不全)行悬吊式免气腹三孔腹腔镜胆囊切除术的临床资料,术中使用框架拉钩、克氏针作为腹壁悬吊装置,应用腹腔镜操作器械完成手术。结果:26例手术均获成功,无一例中转开腹,手术过程顺利,手术时间50~70 min,平均(56.4±2.6)min;无腹腔及脐部切口感染;平均住院(7.0±1.6)d,患者均顺利出院。结论:对于年老体弱、合并心肺功能不全的患者,悬吊式免气腹三孔腹腔镜胆囊切除术优势明显,具有临床推广价值。     

Hemodynamic changes during gaseous and gasless laparoscopic cholecystectomy

Abstract. Purpose: The main disadvantage of gaseous laparoscopic surgery is the need for CO₂ insufflation and the elevation of intra-abdominal pressure. Gasless laparoscopic surgery is an alternative to gaseous laparoscopic surgery, which avoids the hazardous effects of pneumoperitoneum. This study was conducted to investigate the hemodynamic effects of pneumoperitoneum and to compare gasless and gaseous laparoscopic cholecystectomy on a hemodynamic basis. Methods: The gasless laparoscopic procedure uses an electromechanical retractor system to lift the abdominal wall. We performed 20 gaseous and 11 gasless laparoscopic cholecystectomies in a collective total of 31 patients with symptomatic gallostones. The mean arterial pressure, heart rate, end diastolic index, systemic vascular resistance index, cardiac index (CI), ejection fraction (EF), and stroke index (SI) values were monitored noninvasively by thoracic electrical bioimpedance. Results: In the gaseous group, statistically significant changes were detected in CI, EF, and SI values after insufflation as compared to the values before pneumoperitoneum. In the gasless group, only minimal changes were detected in the SI values, which were not significant. Conclusion: Gasless laparoscopy has little effect on the hemodynamic parameters of patients and provides an alternative to the gaseous technique in selected cases. Received: December 6, 2000 / Accepted: January 8, 2002     

Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy using low-pressure pneumoperitoneum (8 mmHg) minimizes adverse hemodynamic effects, reduces postoperative pain, and accelerates recovery. Similar claims are made for gasless laparoscopy using abdominal wall lifting. The aim of this study was to compare gasless laparoscopic cholecystectomy to low-pressure cholecystectomy with respect to postoperative pain and recovery. Methods: Thirty-six patients were randomized to low-pressure or gasless laparoscopic cholecystectomy using a subcutaneous lifting system (Laparotenser). Results: The characteristics of the patients were similar in the two groups. The procedure was completed in all patients in the low-pressure group, but two patients in the gasless group were converted to pneumoperitoneum. There were no significant differences in postoperative pain and analgesic consumption, but patients in the gasless group developed shoulder pain more frequently (50% vs 11%, p < 0.05). Gasless operation took longer to perform (95 vs 72.5 min, p= 0.01). Conclusions: Gasless and low-pressure laparoscopic cholecystectomy were similar with respect to postoperative pain and recovery. The gasless technique provided inferior exposure and the operation took longer, but the technique may still have value in high-risk patients with cardiorespiratory disease. Received: 10 August 1998/Accepted: 12 February 1999     

非气腹腹腔镜在子宫肌瘤剔除手术中的应用

目的探讨非气腹腹腔镜在子宫肌瘤剔除术中的应用。方法比较非气腹腹腔镜（32例）与气腹腹腔镜（21例）的手术时间、术中出血量、有无术后肩胛痛、住院费用及复发率。结果两组手术均顺利完成,无术中、术后并发症发生。非气腹组手术时间（81．41±17．93）min,明显少于气腹组手术时间（92．14±16．17）min,（t=2．215,P=0．031）;非气腹组术中出血量（80．31±21．02）ml,明显少于气腹组术中出血量（92．86±21．25）ml,（t=2．116,P=0．039）;气腹组有38．9％（16／21）的患者出现术后肩胛痛,而非气腹组无一例患者发生,差异有统计学意义（P=0．002）。两组术后均无一例复发。结论非气腹腹腔镜手术治疗子宫肌瘤具有适应证广、操作简单、复发率低等优点,具有良好的应用前景。     

Development and clinical application of semi-loop-shaped retractor for gasless laparoscopic surgery

Background: Gasless laparoscopy has the advantage of avoiding the risk inherent in pneumoperitoneum, but has not gained widespread popularity because of limited exposure of the operative field. Improved retraction devices are therefore needed. Methods: A loop-shaped metallic retractor was designed for planar lifting of the anterior abdominal wall. Four types of retractor (5/6-, 3/4-, and 1/2-circle with rod at 90°, and 1/2-circle with rod at 97°) were studied in 15 pigs. The device was then used for 47 patients. Results: The 1/2-circle was the most smoothly inserted retractor and was significantly safer than the 5/6-circle (p < 0.05, Fishers exact probability test). The 1/2-circle with rod at 97° was utilized for clinical cases. This retractor can be readied within 1 min and was used successfully for all operations. Conclusions: This new retractor for gasless laparoscopic surgery provides good exposure and has the potential to enhance the performance of advanced laparoscopic surgery.     

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。     

自制的腹壁提升器在免气腹腹腔镜手术的应用体会

目的总结自制的腹壁提升器进行免气腹腹腔镜手术的经验.方法应用自制的腹壁提升器对15例病人实施手术,包括胆囊切除手术12例,阑尾切除手术3例,采用连续硬膜外麻醉.结果 15例病人手术皆取得成功,无中转开腹者.手术时间50～215 min(平均89 min),住院日为4～40 d(平均13.6 d),术后都无手术及心血管、肺部并发症发生,术后3～6 d内出院.住院平均费用5 487元.结论应用自制的腹壁提升器进行免气腹腹腔镜手术是一项费用低廉、安全可靠、适合中国国情、值得推广的手术方法,是气腹腹腔镜手术的有益补充.