针型腹腔镜与普通腹腔镜胆囊切除术应激反应比较

目的 为了客观地比较针型腹腔镜胆囊切除术（NLC）和普通腹腔镜胆囊切除术（LC）患者的应激反应程度，随机选择24例NLC患者和22例LC患者进行前瞻性研究，比较两种术后的疼痛程度，体温变化，肠蠕动恢复时间，激素水平变化，C-反应蛋白和白细胞计数的变化。结果 NLC组的术后发热反应和术后镇痛剂用量均明显地于LC组；NLC组的急性相蛋白反映物中的C-反应蛋白浓度变化和白细胞计数的变化较LC组小；两组激素变化无显著差异。结论 NLC组的应激反映程度明显轻于LC组，恢复明显早于LC组。     

不同麻醉方法腹腔镜胆囊切除术对应激反应的影响

目的 观察在硬膜外麻醉和全身麻醉下,腹腔镜胆囊切术中血浆肾上腺素（Ｅ）和 腺素（ＮＥ）Ｒ 变化。方法将３０例拟行腹腔镜胆切除（ＬＣ）２,随机分为全麻组（ＧＡ组,１５例）和硬膜外麻醉组（ＥＡ组,１５例）监测麻醉前、气腹前、气腹时及术毕各时相点血浆ＮＥ及Ｅ浓度。结果ＥＡ组术中香相点ＮＥ水平均无明显变化,气腹前及气腹时Ｅ明显增高,术毕基本恢复;ＧＡ组气腹前ＮＥ及Ｅ无明显变化,气腹时ＮＥ和Ｅ均明显增高,术     

腹腔镜胆囊切除术的手术时间对机体应激反应的影响

目的研究腹腔镜胆囊切除术时间长短对机体应激反应的影响。方法将40例需行腹腔镜胆囊切除术患者按手术时间长短分为A组（〈1h）和B组（≥1h），每组20例。围手术期测c反应蛋白（CRP）、白介素6（IL-6）、促肾上腺皮质激素（ACTH）及皮质醇浓度，并观察术后体温、疼痛情况。结果术后第1天最高体温A组低于B组[（37．1±0．4）℃VS（37．5±0．7）℃，t=-2．219，P=0．033]。术后疼痛评分A组低于B组[中位数2（2—4）VS4（3—6），，=3．806，P=0．021]；血IL-6、CRP、ACTH和皮质醇两组手术后均明显升高（P〈0．05），且B组升高比A组明显。结论腹腔镜胆囊切除术手术时间延长增强了机体术后应激反应。     

腹腔镜与开腹胆囊切除术围手术期病人应激反应的对比研究

腹腔镜胆囊切除术 (ＬＣ)手术时间短 ,其具对腹腔脏器干扰小、病人痛苦轻、术后恢复快 ,瘢痕小、住院时间短等突出微创的优点 ,是治疗胆囊结石并慢性胆囊炎或胆囊息肉的首选方法。手术创伤可引起机体的一系列应激反应 ,通过比较腹腔镜胆囊切除术与开腹胆囊切除术 (ＯＣ)围手术期应激反应的规律探讨ＬＣ的微创机制。资料与方法　　前瞻性随机选取 2 0 0 0年 1月～ 2 0 0 1年 12月因慢性胆囊炎并胆囊结石入院需行胆囊切除术者 6 0例 ,随机分为两组 ,①ＬＣ组 :30例全麻下行腹腔镜胆囊切除术 ,②ＯＣ组 :30例全麻下行开腹胆囊切除术。 6 0例术…     

腹腔镜胆囊切除术对胆结石患者术后应激反应及胃肠功能恢复的影响

目的 探讨实施腹腔镜胆囊切除术治疗胆结石患者对应激反应指标的影响。方法 选择2020年1月至2022年3月句容市人民医院收诊治疗的胆结石患者78例,根据随机数字表法分为对照组(39例)与观察组(39例)。对照组患者采取小切口手术治疗,观察组患者实施腹腔镜胆囊切除术治疗,监测对比两组患者手术前后应激指标变化,记录胃肠功能恢复用时情况,对比胃肠激素水平变化。结果 观察组患者术后内皮素、皮质醇水平均明显低于对照组,血清超氧化物歧化酶高于对照组(P <0.05)。观察组患者术后恢复时间短于对照组,胃动素、胃泌素监测浓度均高于对照组,差异均有显著性(P <0.05)。结论 实施腹腔镜胆囊切除术治疗胆结石患者,能够有效降低患者术后应激反应,同时促进胃肠功能恢复。     

腹腔镜胆囊切除术前评估与术后恢复

自 198 7年ＰｈｉｌｌｉｐＭｏｕｒｅｔ在法国里昂首次利用腹腔镜行胆囊切除术 (ｌａ ｐａｒｏｓｃｏｐｉｃｃｈｏｌｅｃｙｓｔｅｃｔｏｍｙ ,ＬＣ )以来 ,即在腔镜外科掀起了一场浪潮。上世纪 90年代初期这项技术就被引进到我国 ,经过 10年的发展 ,ＬＣ已进入了成熟阶段。它以创伤小倍受医师和患者的青睐。胆囊结石的发病率在胆石症中所占的比例有越来越高的趋势 ,上世纪 5 0年代 ,胆囊结石在胆石症患者中占 3 6.4% ,80年代占 5 2 .8% ,到了 90年代占 79.9% [1] 。现在越来越多的胆囊结石患者要求行ＬＣ ,但由于此技术本身固有的因素 ,因而…     

老年患者腹腔镜胆囊切除术后应激反应及疲劳综合征的临床观察

目的：探讨老年患者行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的应激反应及疲劳综合征的表现。方法：回顾分析2008年10月至2012年10月为160例老年患者行LC的临床资料,根据患者病情决定手术方式,并将其分为腹腔镜组与开腹组,每组80例,分别于术前及术后第1天、第2天、第3天测定两组患者皮质醇、C反应蛋白（C reactive protein,CRP）、中性粒细胞、白细胞（white blood cell,WBC）、白介素-6（interleukin-6,IL-6）及IL-10水平,并对比分析两组患者手术情况及术后疲劳评分。结果：两组手术时间差异无统计学意义（P〉0.05）,两组术中出血量、术后住院时间差异有统计学意义（P〈0.05）。与术前相比,两组患者术后IL-6、IL-10及CRP水平差异均有统计学意义（P〈0.05）;术后中性粒细胞、WBC两组患者均有所增高,差异有统计学意义（P〈0.05）;皮质醇均较术前有所降低,差异有统计学意义（P〈0.05）。两组间相比,腹腔镜组IL-6、CRP水平较开腹组低,差异有统计学意义（P〈0.05）;但IL-10水平较开腹组高（P〈0.05）;两组患者皮质醇增高程度差异有统计学意义（P〈0.05）。两组术前疲劳评分差异无统计学意义（P〉0.05）,与术前相比,两组患者术后疲劳评分差异均有统计学意义（P〈0.05）,且两组间相比差异亦有统计学意义（P〈0.05）。结论：老年患者脏器功能呈衰退表现,手术时容易出现明显的应激反应,LC患者创伤小,可显著减轻创伤所致的应激反应,同时患者术后疲劳综合征减轻,康复快。     

腹腔镜胆囊切除术对应激的影响

为了探讨腹腔镜胆囊切除术(LC)对应激影响的客观指标，我们在1995．1～5月间对15例LC病人，7例开腹胆囊切除术(OC)病人，在围手术期进行了应激激素的前瞻性动态观察。分别在术前、术终，术后第1、2、3d检测血中去甲肾上腺素(NE)，肾上腺素(E)、皮质醇、胰岛素、C肽、生长激素(GH)的水平。结果除了E在LC组无明显变化外，其余激素在两组术终时均达高峰(P<0.01)。OC组NE峰值均高于LC组峰值(P<0.05)；术后第2、3d胰岛素水平OC组高干LC组(P<0．01)；术后第3d OC组皮质醇、C肽高干LC组(P<0．01)；与术前相比，OC组术后第1d NE仍保持高水平(P<0.01);术后第3d OC组皮质醇再次升高(P<0．01);胰岛素在OC组术后1d、2d维持高水平(P<0.05)。因此，我们认为LC不但能明显减轻应激反应的强度，而且能大大缩短应激反应的时间。     

Zeus手术机器人胆囊切除术与常规腹腔镜胆囊切除术的对比研究

目的探讨Zeus手术机器人用于胆囊切除术的价值。方法将40例择期胆囊切除术患者分为Zeus手术机器人胆囊切除组(A组)和腹腔镜胆囊切除组(B组),每组20例。结果A组擦镜次数(1.1±1.0)次和调整术野时间(2.2±0.7)min显著少于B组(4.5±1.5)次,(7.5±1.2)min。A组解剖动作次数(337±86)次和操作失误率(10%)少于B组(389±94)次,(25%)。A组手术时间(104.9±20.5)min和系统建立时间(29.5±9.8)min显著长于B组(78.6±17.1)min,(12.6±2.5)min。两组术中出血量(35.6±25.2)ml∶(31.8±16.4)ml和术后住院天数(2.8±0.8)d:(2.8±0.7)d相近,均无术后并发症,各有1例中转开腹手术。结论手术机器人胆囊切除术与腹腔镜手术相比,手术时间长,但术野控制能力好,动作精确性和稳定性更大。     

单孔腹腔镜与传统腹腔镜胆囊切除术治疗效果比较

目的 探讨单孔腹腔镜(SILC)与传统腹腔镜两种术式的安全性和可行性.方法 选取胆囊疾病患者54例随机分为SILC组(n=26)和三通道腹腔镜胆囊切除术(3PLC)组(n=28).收集患者年龄、体质量、身高、体质量指数(BMI)、手术时间、疼痛分数、中途转换手术率、切口满意度评分等临床资料,并进行了12个月的随访.结果 两组患者在性别、年龄、体质量、身高和BMI方面比较差异无统计学意义(P＞0.05).SILC组手术时间长于3PLC组[(56.9 ±15.8) min比(35.2±8.7) min,P＜0.01].应用相同的麻醉药品后SILC组在术后第1天较3PLC组疼痛分数更高,总的疼痛分数两者相似,差异无统计学意义(P＞0.05).SILC组患者术后伤口并发症发生率更高,但术后疝发生率相同.SILC组切口满意度评分分数更高[(11.7±0.8)分比(10.1±1.2)分,P＜0.05].结论 SILC较3PLC治疗单纯胆道疾病安全、有效.     

Evaluation of oxidative stress in laparoscopic cholecystectomy

Purpose: We conducted a prospective study to evaluate the effect of CO₂ pneumoperitoneum and increased intra-abdominal pressure on arterial blood gases, end-tidal CO₂ (ETCO₂), nitric oxide (NO), blood and tissue malondialdehyde (MDA), and total antioxidant (TAOx) levels during laparoscopic cholecystectomy. Methods: Fifty selected patients with cholelithiasis were randomized to undergo either laparoscopic or open surgery. Blood samples were taken pre-, mid-, and postinsufflation, and 24 h postoperatively. To determine the tissue MDA level, tissue samples were taken from the gallbladder just after removal. Results: The increased levels of ETCO₂ and PCO₂, caused by CO₂ pneumoperitoneum resulted in a minimal decrease in blood pH during the laparoscopic surgery. Although low levels of blood MDA were seen 30 min after the start of laparoscopy, due to less oxidative stress response and tissue trauma, increased levels of tissue MDA levels indicated that the gallbladder was more traumatized during laparoscopic dissection and handling. NO levels were slightly lower in the laparoscopic cholecystectomy (LC) group, but there were no significant differences compared with the open cholecystectomy group (OC). TAOx levels were similar in both groups 30 min after the start the procedure, but were much lower in the LC group 24 h postoperatively. Conclusions: These findings suggest that the antioxidant defense system is stimulated less with less oxidative stress, providing further evidence to support the opinion that LC is a safe technique. Received: June 13, 2001 / Accepted: March 5, 2002     

Robot-assisted laparoscopic Roux-en-Y gastric bypass

Background Robotic surgery promises to extend the capabilities of the minimally invasive surgeon. The aim of this study was to examine the feasibility of robotic surgery in the setting of laparoscopic gastric bypass.Methods The Zeus robotic surgical system was used in 50 laparoscopic gastric bypass procedures. The learning curve was staged to add complexity to the robotic tasks as experience grew. Robotic setup time, robotic operative time, total operative time, and operative outcomes were tracked prospectively.Results We observed a significant decrease in the robotic setup time. Our robotic learning curve demonstrated decreased operative time, even as more complex tasks were accomplished. Total operative time also decreased significantly over the series. There were no complications in our series that could be attributed to the robotic technique.Conclusions Robot-assisted laparoscopic Roux-en-Y gastric bypass is safe. The steadiness and extra degrees of freedom of surgical robotic systems may improve the accuracy of laparoscopic tasks. The learning curve for robot-assisted laparoscopic Roux-en-Y gastric bypass is significant but manageable.Presented at the annual meeting of the Society of American Gastrointesinal Endoscopic Surgeons (SAGES), Denver, CO, USA, 1 April 2004     

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.     

A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy

Background: Elective laparoscopic cholecystectomy (LC) has a low risk for infective complications, but many surgeons still use prophylactic antibiotics. The use of prophylactic antibiotics for LC is inconsistent and varies widely among surgeons. Methods: We performed a prospective double-blind randomized study of prophylactic antibiotics in elective LC. Antibiotics were was given first before the operation and then again 24 h afterward. Group A (n = 49) received 2 g of cefotaxime; group B (n = 43) received 10 ml of isotonic sodium chloride solution. A sample of bile was withdrawn by direct gallbladder puncture for anaerobic and aerobic cultures. Age, sex, weight, duration of surgery (DOS), presence of diabetes mellitus, American Society of Anesthesiologists (ASA) classification, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, episodes of colic within 30 days before surgery, length of stay (LOS), and number of septic complications were recorded for both groups. Results: There was no differences between the two groups in terms of sex, weight, DOS, ASA score, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, or LOS. One infection occurred in the antibiotic prophylaxis group (2.04%); in the patients not receiving antibiotics, there was one other infection (2.32%). There was no statistical difference between the two groups in infective complications. Conclusion: In patients undergoing elective LC, antibiotic prophylaxis is justified only in high-risk patients. In all other patients, antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications. In low-risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction; moreover, it would lower the risk of adverse reaction and reduce microbial resistance. Presented at the combined meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the 8th World Congress of Endoscopic Surgery, New York, NY, USA, 13–16 March 2002     

腹腔镜胆囊切除术后胆漏的原因分析

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆漏的原因及防治方法。方法总结LC后并发8例胆漏的诊治经验。结果 LC后8例胆漏病例中肝外胆道损伤2例,肝总管壁电凝烧灼伤1例,胆囊床毛细胆管渗漏3例,迷走胆管漏1例,胆囊管钛夹脱落1例。均经相应治疗痊愈出院。结论肝外胆管、迷走胆管损伤及胆囊管残端钛夹脱落是腹腔镜胆囊切除术后胆漏的主要原因,建立通畅的腹腔引流,行胆总管修补、T管支持引流或胆肠吻合是治疗腹腔镜胆囊切除术后胆漏、预防并发症出现的主要方法。     

A simple method of infundibular retraction during laparoscopic cholecystectomy

Summary Laparoscopic excision of the gallbladder has rapidly become a preferable technique for treating patients with symptomatic cholelithiasis. To date, new developments in instrumentation have hardly been able to keep pace with the rising popularity of this method. The use of techniques applied to other areas of endoscopy may be useful when adapted to laparoscopic surgery. We discuss herein the use of a standard colonoscopic polypectomy snare for retraction of the gallbladder during laparoscopic cholecystectomy. This adaptation facilitates the procedure and avoids the need for an additional trocar puncture.     

经脐单孔与常规腹腔镜胆囊切除术比较分析

目的探讨经脐单孔腹腔镜胆囊切除术的优越性。方法选择2009年3至8月间收治的60例行腹腔镜胆囊切除术的患者,随机分成两组。30例行经脐单孔腹腔镜胆囊切除术（单孔组）,其中胆囊息肉19例,胆囊结石11例;平均病史1～2年,无急性炎症;于脐部做一1.5～1.8cm弧形切口,应用与常规腹腔镜胆囊切除术相同的方法建立腹腔镜操作通道并维持气腹完成胆囊切除。30例行常规（三孔或四孔法）腹腔镜胆囊切除术（常规组）,其中胆囊息肉5例,胆囊结石15例,胆囊炎10例;平均病史2～3年,无急性炎症。结果所有手术均获成功。单孔组除第1例手术时间为60min外,其余29例平均手术时间为20～40min;均未放置引流管,无出血及胆漏等并发症发生,患者清醒后即可饮水,2～3d出院,术后两周复查,脐部无明显手术瘢痕。常规组平均手术时间为40min,5例放置引流管,无明显出血及胆漏等并发症发生,平均术后5d出院,脐部及上腹部手术瘢痕明显。结论经脐单孔腹腔镜胆囊切除术是安全可行的,但操作难度较常规腹腔镜胆囊切除术大,脐部操作装置及手术器械有待进一步完善和改进,但较常规腹腔镜胆囊切除术更加微创,极具推广价值。     

遥控Zeus手术机器人与腹腔镜胆囊切除术后免疫功能的比较

目的比较遥控Zeus手术机器人胆囊切除术(RLC)与常规腹腔镜胆囊切除术(CLC)对患者术后免疫功能的影响。方法收集1年内诊治的胆囊结石、胆囊息肉患者5 2例的临床资料,其中行RLC 2 3例,CLC 2 9例。对两组手术前后免疫功能指标如T细胞亚群,IgA,IgM,IgG及补体C 3和C 4的变化进行比较。两组手术均顺利完成。结果RLC手术前后CD 4/CD 8分别为1.5 6±0.6 7和1.3 0±0.5 3,IgM分别为1.4 2±0.5 8和1.2 6±0.4 6,术后均有显著下降(P<0.0 5)。CLC手术后C 3从1.4 8±0.3 4下降至1.3 8±0.2 8,C 4则从0.2 5±0.0 9下降至0.2 2±0.0 7,差异有统计学(P<0.0 5)。两种手术方式手术前后所测定的其他免疫指标均无明显差异(P>0.0 5),且两组间差异无显著性(P>0.0 5)。结论RLC与CLC对患者术后细胞免疫功能的影响均不明显;但均对体液免疫功能有一定影响。