基层医院高龄胆囊结石患者治疗的探析

目的：探讨基层医院高龄胆囊结石患者的外科治疗特点。方法：回顾性分析152例65岁以上高龄老年胆囊结石患者手术治疗的临床资料。结果：152例中100例（66%）合并其他疾病,152例病人均经手术治疗,术式以胆囊切除、胆道探查为主,胆囊切开取石＋胆囊造瘘3例,共治愈124例（82%）。结论：掌握手术适应症和手术时机,积极处理并存病,是减少老年胆道病人术后并发症,降低病死率的关键。     

腹腔镜胆囊切除胆道探查术用于胆囊结石伴胆总管结石的治疗价值分析

目的:分析腹腔镜胆囊切除胆道探查术用于胆囊结石伴胆总管结石的治疗价值.方法:本研究中将我院住院部收治胆囊结石伴胆总管结石患者60例作为观察对象.60例患者应用数字随机表方法进行分组处理.对照组患者采用开腹手术治疗,观察组患者采用腹腔镜胆囊切除胆道探查术治疗.对比两组患者围术期相关指标以及术后并发症发生率差异.结果:观察组患者手术切口为(3.8±0.6)cm,手术耗时为(72.8±18.6)min,术中出血量为(38.1±10.2)ml.观察组患者并发症发生率为3.33%(1/30),显著低于对照组(P<0.05),差异显著且有统计学意义.结论:应用腹腔镜胆囊切除胆道探查术治疗胆囊结石伴胆总管结石具有手术切口小、手术耗时短、术中出血量少、并发症发生率低等优势,值得临床应用.     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的安全性和有效性研究

目的:研究腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的安全性和有效性.方法;本次研究对象为2014年5月~2016年5月间在我院接受治疗的胆囊结石合并胆总管结石患者80例,采用不同的手术方法将其分成对照组(n=40例)与观察组(n=40例),观察组采用腹腔镜胆囊切除联合胆道镜胆总管探查并T管引流术治疗,对照组采用开腹胆囊切除和胆总管取石治疗,比较两组患者术后相关指标和并发症发生情况.结果;观察组患者和对照组患者的手术时间比较,不具有统计学意义p>0.05;观察组患者的肛门排气时间、术中出血量、住院时间明显少于对照组,差异具有统计学意义,p<0.05.观察组手术后并发症发生率为7.5%明显少于对照组手术后并发症发生率22.5%,差异具有统计学意义,p<0.05.结论;胆囊结石合并胆总管结石患者采用腹腔镜胆囊切除联合胆道镜胆总管探查并T管引流术治疗,能一次性彻底取石、术后恢复,有效的缩短了住院时间短,值得临床推广应用.     

老年胆囊穿孔围手术期处理31例分析

目的 通过对老年胆囊穿孔诊治特点的分析,提高围手术期处理经验.方法 对31例老年胆囊穿孔患者的临床资料进行回顾性分析.有慢性胆囊炎并结石病史者29例(93.55%),并存内科疾病23例(74.19%).行单纯开腹胆囊切除术26例;胆囊切除加胆道探查T管引流术2例;术中部分切除或未切除胆囊,采用以石炭酸为主的化学灭活和电灼物理去胆囊黏膜化处理3例.结果 31例患者中术后发生并发症13例(41.94%),1例因多器官功能衰竭死亡,30例治愈出院.结论 老年人的生理及病理特点使其临床表现不典型,加之合并症较多见,术后并发症发生率高.选择合适的手术时机、麻醉及手术方式,并加强围手术期内科处理,是提高老年胆囊穿孔外科治疗效果的重要因素.     

经胆囊管胆道镜治疗继发性胆总管结石23例

目的:探讨胆囊切除术中经胆囊管纤维胆道镜检查、取石对继发性胆总管结石的诊断及治疗价值.方法:对23例有胆总管探查指征、高度怀疑有胆总管继发性结石的患者,在胆囊切除术中经胆囊管用胆道镜探查并清除结石.结果:术中发现胆总管结石11例(47.8%),10例成功取出结石,阴性探查12例(52.2%),其中8例发现胆总管下段粘膜充血水肿,提示可能有过结石存在,已排入肠道.结论:对继发性胆道结石,术中应用纤维胆道镜经胆囊管探查胆总管,是一安全、有效的方法,它提高了继发性胆总管结石阳性诊断率及降低结石残留率,无明显并发症.     

应用胆道镜经胆囊管行胆道探查39例临床分析

目的：分析胆囊切除时应用经胆囊管纤维胆道镜探查胆道的临床应用价值。方法：2002年开始对胆囊切除时伴有胆道探查指征的39例病人,根据胆囊管的情况,应用经胆囊管纤维胆道镜探查胆道,并根据纤维胆道镜探查情况,采取相应的处理。结果：本组39例有35例完成探查,其中探查阴性19例,阳性16例,14例胆道镜下完成手术,2例改行胆总管切开探查,成功率94％（33／35）,术后病人恢复良好,无严重并发症,住院时间缩短,费用降低。结论：经胆囊管纤维胆道镜探查胆道降低了胆总管探查的阴性率及结石残留率,创伤小,恢复快,费用低,值得临床推广应用。     

腹腔镜胆囊切除胆道探查术治疗胆囊结石合并胆总管结石的效果研究

目的对比与分析腹腔镜胆囊切除胆道探查术与传统开腹手术在胆囊结石合并胆总管结石治疗中的临床应用疗效。方法选取2013年1月至2016年1我院收治的胆囊结石合并胆总管结石患者80例分为观察组(48例)和对照组(32例)。观察组行腹腔镜胆囊切除胆道探查术,对照组行传统开腹手术治疗。对比两组手术治疗效果、手术时间、术中出血量、术后通气时间、住院时间以及并发症发生率。结果观察组的治疗总有效率为97.9%,明显高于对照组的75.0%(P<0.05);观察组的手术时间、术中出血量、术后通气时间和住院时间均少于对照组(P<0.05);观察组的并发症发生率为2.1%,明显低于对照组的21.9%(P<0.05)。结论在胆囊结石合并胆总管结石的治疗中,相比于传统开腹手术,腹腔镜胆囊切除胆道探查术的疗效确切,创伤小,而且能够缩短患者康复时间。     

老年胆石症50例的手术治疗分析

目的:探讨老年胆石症的手术治疗时机、术式及并发症.方法:对50例老年胆石症患者的手术治疗情况进行总结分析.其中行急诊手术27例,择期手术23例.单纯胆囊切除术28例,胆囊切除 胆总管切开取石"T"管引流术17例,胆总管十二指肠吻合术3例,胆囊造瘘术2例.结果:手术后44例治愈(占88%),3例好转(占6%),3例死亡(占6%).结论:对老年胆石症的手术治疗要在明确诊断的基础上选择合理术式、掌握手术时机,同时加强围手术期处理,积极治疗伴随疾病和并发症,才能提高疗效.     

老年胆道病人围手术期处理(附76例报告)

探讨老年胆道疾病围手术期处理。结果，76例老年胆道疾病患者中并存病52(68．5％)，术后并发症21例(27．6％)，病死率3．9％。故老年胆道病人并存病多，术后并发症发病率高，做好围手术期处理，掌握适当手术时机，采用合理术式，外科手术对老年胆道疾病是一个有效安全的治疗方法。     

腹腔镜联合胆道镜治疗胆总管结石临床分析

目的探讨腹腔镜联合胆道镜治疗胆总管结石的临床疗效。方法回顾性分析59例经影像学检查确诊为胆总管结石患者的临床资料及随访结果。经胆囊管胆道镜探查胆总管取石34例;胆总管切开胆道镜探查取石胆总管一期缝合12例;胆总管切开胆道镜探查加T管引流术13例。结果 59例均顺利完成手术,无一例中转开腹。一期缝合术后2例发生短暂胆漏,经3～5d引流后胆漏自行愈合。手术时间65～165min;术中出血40～180ml;住院6～10d,随访1～2年无复发结石。结论腹腔镜联合胆道镜治疗胆总管结石,具有微创手术的优点,安全有效,并发症少,可替代传统的开腹胆总管切开探查T管引流术。     

原发性胆囊癌的外科治疗(附59例分析)

目的 总结原发性胆囊癌的治疗经验，探讨提高原发性胆囊癌的诊断和治疗效率。方法 回归性分析本院1985-01～1999-12收治的59例原发性胆囊癌且行手术治疗患者的临床资料。结果 本组患者中男22例，女37例，男女之比为l：1.68，59％(35／S9)的病例合并有胆囊结石。最常见的临床症状和体征依次是右上腹疼痛、黄疸和右上腹包块。本组胆囊切除率56％(33／59)。病理检查示胆囊腺癌占94％(53／56)。术后总的1、3、5年生存率分别为36％(21／59)、20％(12／59)和10％(6／59)，但早期患者与晚期患者术后1、3、5年生存率有明显的差别，根治术与非根治术后1、3年生存率亦有明显的差别。结论 重视胆囊癌的诊断，早期发现和根治性切除是提高手术疗效的关键，对有高危因素胆囊结石患者，应行预防性胆囊切除。     

89例老年结石性胆囊炎诊治体会

目的：探讨老年结石性胆囊炎外科治疗时机和方式。方法：回顾性分析89例老年结石性胆囊炎手术治疗的临床资料。结果：89例老年结石性胆囊炎手术者全部治愈。结论：掌握手术适应证及时机,能减少术后并发症及降低手术死亡率。     

逍遥散加减治疗慢性结石性胆囊炎的疗效观察

目的 探讨逍遥散加减治疗肝郁脾虚证慢性结石性胆囊炎（chronic calculous cholecystitis,CCC）的临床疗效。方法 随机将2018年12月—2020年6月中国人民解放军联勤保障部队第921医院收治的118例肝郁脾虚证CCC患者分为两组,对照组59例,治疗组59例。对照组给予饮食干预、复方阿嗪米特肠溶片、熊去氧胆酸、非甾体类消炎止痛药等综合治疗,治疗组在对照组基础上加用逍遥散加减辨证治疗,两组疗程均为4周。统计分析两组的中医证候疗效和超声影像学疗效,比较两组治疗前后中医证候积分、健康状况调查简表（the MOS item short from health survey,SF-36）评分、胆囊功能的变化。结果 治疗组的中医证候总有效率94.92%(56/59),明显高于对照组83.05%(49/59),差异有统计学意义（P <0.05）;治疗组超声总有效率89.83%(53/59),明显高于对照组74.58%(44/59),差异有统计学意义（P <0.05）;治疗后,与对照组比较,治疗组中医证候积分降低,差异有统计学意义（P <0.05）,SF...     

腹腔镜胆总管切开取石T管引流术在老年患者中的应用

目的总结老年患者腹腔镜胆总管切开取石T管引流术的临床经验。方法回顾性分析56例胆囊合并胆总管结石患者在腹腔镜下行胆囊切除及胆总管切开取石术的术式及病例资料特点。结果52例在腹腔镜联合胆道镜下成功行胆囊切除及胆总管切开取石T管置入术,无死亡病例。结论腹腔镜联合胆道镜行胆囊切除、胆总管切开探查取石、T管引流术具有安全可靠、损伤小、康复快、住院时间短等优点,是治疗胆囊结石、胆总管结石的有效方法。     

原发性胆囊癌32例韵诊治体会

目的探讨原发性胆囊癌的早期诊断和治疗方法。方法回顾分析32例原发性胆囊癌患者的诊治资料。结果术前确诊率仅为46．9％（15／32）。单纯胆囊切除4例,胆囊加肝楔形切除6例,胆囊加肝楔形切除加区域淋巴结清扫7例,胆肠内引流2例,胃空肠吻合1例,仅行剖腹探查4例,非手术治疗8例。结论B超和CT是早期诊断胆囊癌的主要手段。手术切除是最佳选择,术后综合治疗有重要意义,肿瘤的基因治疗正逐渐发展成为治疗原发性胆囊癌的一种新方法,已显示出良好的应用前景。     

Low incidence of hospitalization with gallbladder disease among blacks in the United States

Low rates of gallbladder disease among blacks have been reported but not systematically studied. The authors investigated the rate of hospitalization with a diagnosis of gallbladder disease in the follow-up in 1982-1984 of the first National Health and Nutrition Examination Survey, a population-based study conducted across the United States in 1971-1975. Based on hospital discharge diagnoses of gallbladder disease, 368 cases were identified for the period 1971-1984 among 10,551 persons, aged 25-74 years, who denied gallbladder disease at the baseline examination. The crude incidence of gallbladder disease per 1,000 person-years was 2.59 for white men, 1.45 for black men, 4.09 for white women, and 2.35 for black women. Controlling for obesity, parity, ethanol consumption, use of diuretics, use of oral contraceptives, and two indicators of socioeconomic status, the authors found that the hazard rate of hospitalization with gallbladder disease increased with age for white women and decreased for black women. The hazard ratio for black women compared with white women at 30 years of age was 0.71 with a 95% confidence interval of 0.52-0.96, but at age 70, it was 0.18 with a 95% confidence interval of 0.09-0.37. For women, obesity and parity were important risk factors for gallbladder disease (p less than or equal to 0.001), and the use of diuretics was marginally associated (p = 0.08). Black men compared with white men had a hazard rate of gallbladder disease of 0.53 with a 95% confidence interval of 0.24-1.16. For men, increasing age was related to gallbladder disease (p less than 0.001), and obesity was weakly related (p = 0.06). The black/white hazard ratios decreased further when controlling for socioeconomic status, persisted if the study population was limited to those hospitalized during follow-up, and increased slightly for cases with an acute complication of gallbladder disease. Thus, differential access to medical care may not explain the lower rate among blacks.     

老年患者良性胆囊疾病腹腔镜胆囊切除与开腹胆囊切除的临床效果比较分析

目的探讨腹腔镜胆囊切除术(LC)与开腹胆囊切除术(OC)用于老年良性胆囊疾病的临床疗效。方法将该院2011年8月—2013年3月收治的116例良性胆囊疾病老年患者随机分为两组,分别采取OC与LC治疗,对两组患者临床资料进行回顾性分析。结果观察组手术时间、术中出血量、胃肠道恢复、下床活动及平均住院时间均明显少于对照组(P<0.05);观察组并发症发生率明显低于对照组(P<0.05)。结论 LC治疗老年良性胆囊疾病效果优于OC,手术创伤小、术后恢复快,安全、有效,值得临床应用和进行推广。     

老年腹腔镜胆囊切除术的临床护理

目的探讨老年腹腔镜胆囊切除术（LC）患者的病理生理特点和围手术期的护理方法。方法对我院70例老年胆囊疾病患者行LC，并采取相应的围手术期护理方法。结果所有患者均成功地施行了LC，无死亡病例，4例中转开腹手术。术后均恢复良好，腹部伤口一期愈合，1例出现心房颤动，1例出现肺部感染，无护理并发症，术后3～7d痊愈出院。结论重视围手术期护理，采用合理的护理措施，对老年患者行LC是安全可行的。     

老年骨折伴心血管疾病患者手术危险因素分析

目的探讨分析合并心血管疾病老年骨折患者的手术风险及其影响因素。方法回顾性分析192例合并心血管疾病的老年骨折患者的临床资料,采用微机多因素分析处理。结果老年骨折伴心血管疾病病人手术危险性大,有显著影响的因素依次为手术时间长、心血管病种类、心功能差和手术部位。结论对围手术期危险性作充分评估,严格掌握手术适应证,选择适当的手术时机,对心血管疾病作相应处理,能降低手术风险。     

Influence on gallbladder volume of early postoperative gastric supply of nutrients

BACKGROUND & AIM: The gallbladder volume is a predictor of biliary stasis and the formation of biliary sludge. Biliary stasis and sludge have been recently recognized as the precursors of acute acalculous cholecystitis, as well as 'idiopathic' postoperative pancreatitis, rare but very serious complications after surgery. The aim of the study was to establish how early postoperative gastric supply of nutrients affects the gallbladder volume in patients after noncardiac and cardiac surgery. METHODS: In the two prospective, randomized studies 40 patients (study I-noncardiac surgery) treated at surgical ICU after major elective extrahepatobiliary and extragastrointestinal surgeries (7 thoracic, 19 vascular, 14 urological) and 40 patients (study II-cardiac surgery) treated at cardiosurgical ICU after CABG surgery were analyzed. In both studies the patients were divided into two groups: control group C (study I: 20 patients, age 45+/-18 yrs, male 65%; study II: 20 patients age 58+/-7 yrs, male 60%) and group E (group of early postoperative gastric supply of nutrients) (study I: 20 patients, age 52+/-17 yrs, male 50%; study II: 20 patients; age 59+/-8 yrs, male 65%). For the first 24 hours the patients in group C received only crystalloid solutions and the gallbladder volume was verified 24 hours after the surgery. In group E, postoperative gastric supply of nutrients began 18 hours after surgery (Osmolite, Ross; first 3 hours 30 ml/h and second 3 hours 50 ml/h; total 240 ml after 6 hours). In all patients sonographic measurement of gallbladder volume was performed immediately before surgery and 6 hours after the start of feeding (24 hours after surgery). The measurement was done with ultrasonographic scanner Hitachi 405 EUB (convex probe 3.5-5MHz) by the same specialist, and the volume was calculated using the ellipsoid method. RESULTS: The gallbladder volume measured by ultrasonography 24 hours after surgery in study I (noncardiac surgery) in group E amounted to 43+/-25 ml while in control group C it was significantly higher, i.e. 67+/-30 ml (P<0.05). In study II (cardiac surgery) in group E gallbladder volume amounted to 59+/-15 ml while in control group C it was also significantly higher, i.e. 71+/-11 ml (P<0.05). CONCLUSION: An early postoperative gastric supply of nutrients after both noncardiac and cardiac adult surgery diminishes the volume and probably stimulates the motility of the gallbladder, thus preventing biliary stasis and the formation of biliary sludge.