上腹部手术后腹腔镜胆囊切除术

自 198 7年法国的Ｍｏｕｒｅｔ首次应用腹腔镜技术完成胆囊切除以来 ,腹腔镜手术便很快在世界各地广泛普及 ,并开创了微创腹部外科手术的新篇章。由于手术操作技巧的提高以及手术器械的不断改进 ,腹腔镜技术的应用已扩展到腹部其它器官 ,腹腔镜胆囊切除术 (Ｌａ ｐａｒｏｓｃｏｐｉｃＣｈｏｌｅｃｙｓｔｅｃｔｏｍｙ ,ＬＣ)的适应证随之大大放宽。早期的一些绝对禁忌证 ,如妊娠、腹部手术史、肥胖、不能耐受全身麻醉、凝血机制障碍、肝硬化、胆总管结石及急性胆囊炎等 ,已不成为禁忌证或仅为相对禁忌证[1] 。本文旨在对有上腹部手术史的患者…     

多次上腹部手术后腹腔镜胆囊切除术22例分析

目的 探讨多次上腹部手术后腹腔镜胆囊切除(LC)的可能性及手术方法及技巧。方法 回顾性分析22例多次(≥2)上腹部手术后LC。结果 LC成功15例,成功率68.2％(15/22)。其中2次上腹部手术后LC成功率63.6％(14/22),3次上腹部手术后LC成功率为1例。7例中转开腹,无手术并发症发生。结论 多次上腹部手术史不应成为LC的禁忌症,但手术难度大,中转开腹手术率增高。     

多次上腹部手术后腹腔镜胆囊切除术

目的　探讨多次上腹部手术后腹腔镜胆囊切除术 (LC)的可行性及特点。　方法　连续进行 35例多次 (≥ 2次 )上腹部手术后LC。　结果　LC成功 2 1例 ,成功率 6 0 0 % (2 1 35 )。 2次上腹部手术后LC成功率 6 2 5 % (2 0 32 ) ,3次上腹部手术后LC成功率为 1 3。 14例中转开腹 ,中转率 4 0 0 % ,平均手术时间 6 8 7min ,中转率与手术时间均明显高于同期无上腹手术病史患者。无手术并发症发生。　结论　多次上腹部手术史不应成为LC的禁忌证 ,但手术难度加大 ,中转率增高 ,手术时间延长 ,对手术医师的要求较高。     

上腹部手术后腹腔镜胆囊切除术43例

目的:探讨腹腔镜胆囊切除术在有上腹部手术史患者中应用的可行性及安全性。方法:43例采用闭合或开放法置入穿刺鞘,使用粘连区分离技术,显露胆囊全貌及Calot三角,常规切除胆囊。结果:39例在腹腔镜下治疗成功,4例中转开腹。1例术后胆瘘。结论:对于有上腹部手术史的胆囊结石患者,只要腹腔镜手术医师具有熟练操作技术,良好的开腹胆囊切除手术经验,腹腔镜胆囊切除术仍是一种安全有效的首选方法。     

腹部手术后腹腔镜胆囊切除术210例分析

随着腹腔镜技术的普及和操作经验的积累,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的适应证不断扩大,有过腹部手术史的患者也能得益于腹腔镜技术而痊愈.我院自2001年3月开展LC以来,共完成1 000例,其中有腹部手术史210例,占21%,临床效果满意,现报道如下.     

上腹部手术史患者腹腔镜胆囊切除术的应用探讨

[摘 要] 目的 探讨既往有上腹部手术史患者行腹腔镜胆囊切除术（LC）的可行性、安全性及应用价值。方法 回顾性分析扬州市中医院2010年6月至2016年6月55例有上腹部手术史患者行LC的临床资料。结果 成功完成LC 53 例,中转开腹2 例,手术时间平均（69.6±22.5）min,术中出血量平均（26.6±12.8）mL,平均住院（4.2±0.8）d。术后无胆管损伤、胆漏、腹腔出血等并发症发生,所有患者均治愈出院。结论 上腹部手术史不是LC的禁忌证,既往有上腹部手术史患者行LC是安全可行的。     

腹部手术后腹腔镜胆囊切除术52例报告

目的:探讨有腹部手术史患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及治疗经验.方法:回顾分析2010年11月至2011年5月为956例患者施行三孔法LC的临床资料,其中52例有腹部手术史(实验组),904例无腹部手术史患者为对照组.两组患者均于气管插管全麻下施术.结果...     

有上腹部手术史病人的腹腔镜胆囊切除术15例

随着腹腔镜手术经验的积累、技术的提高，上腹部手术史已不再是腹腔镜胆囊切除术(Lc)的禁忌证。     

上腹部手术史患者行腹腔镜胆囊切除术的临床体会

目的:探讨有上腹部手术史患者行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)的可行性及要点。方法:回顾分析2004年10月至2010年12月为128例有上腹部手术史的患者施行LC的临床资料。结果:115例成功完成LC,13例中转开腹,成功率89.84%。LC组手术时间35~240m in,平均(67.7±19.4)m in;中转组73~225m in,平均(89.3±16.8)m in。LC组术中出血量5~100m l,平均(23.7±10.6)m l;中转组50~1 000m l,平均(200.6±45.9)m。lLC组术后住院3~5d,平均(3.6±0.8)d;中转组8~23d,平均(11.3±3.4)d。LC组术后无并发症发生;中转开腹组1例切口脂肪液化,1例切口感染,无其他并发症发生。所有病例均治愈出院。结论:有上腹部手术史不应成为LC的禁忌,但具体术式应根据术前判断和患者的具体情况决定。     

合并上腹部手术史的腹腔镜胆囊切除术操作体会

腹部手术史尤其上腹部手术史一直是腹腔镜胆囊切除术的相对禁忌症之一[1],主要原因是该类患者腹腔内常存在较为广泛且致密的粘连,导致镜下分离松解困难,分离过程中容易发生意外出血及胃肠、胆管等重要脏器损伤,     

二次腹部手术后腹腔镜胆囊切除1例

1 病例资料 患者,女性,57岁,因反复右上腹痛10年入院.50年前曾因胆道蛔虫行手术,30年前行剖宫产.入院时查体：上腹正中偏右侧可见手术疤痕,上起剑突下约5 cm处,下至脐右上方约4 cm处,下腹部正中亦有一条手术疤痕,长约8 cm.右上腹压痛,无明显反跳痛及肌紧张,肝脾肋下未触及,未触及包块.     

The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.     

Abdominal Wall Haematoma Complicating Laparoscopic Cholecystectomy

Of 61 consecutive patients undergoing laparoscopic cholecystectomy, 4 (6.25%) developed abdominal wall haematomas. This complication of laparoscopic cholecystectomy may occur more commonly than existing literature suggests, and manifests in the post-operative period (days 2 to 6) by visible bruising, excessive pain or an asymptomatic drop in haematocrit. It is readily confirmed by ultrasonography. While no specific treatment is necessary apart from replacement of significant blood loss, the patient requires reassurance that this apparently alarming complication will rapidly resolve.     

Laparoscopic Transumbilical Cholecystectomy Without Visible Abdominal Scars

Introduction  We present a novel surgical technique for cholecystectomy utilizing three laparoscopic ports placed through the umbilicus. This new method is natural orifice transumbilical surgery (NOTUS) and describes a laparoscopic operation that can be performed with all incisions placed within the umbilicus obviating visible abdominal scars. Objectives  To develop a novel laparoscopic surgical technique for cholecystectomy utilizing only transumbilical incisions. Summary Background Data  Natural orifice translumenal endoscopic surgery (NOTES) has become an exciting area of surgical development. Significant limitations to this surgical concept, however, are lack of surgical expertise and appropriate flexible instrumentation. An alternative and competing technology to NOTES is NOTUS. Methods  We describe a patient in whom a laparoscopic surgical technique for cholecystectomy utilized incisions all placed entirely within the umbilicus. This new technique is called NOTUS and describes a laparoscopic operation that can be performed without visible abdominal scar. Results  The operative time was 70 min. There were no intraoperative complications. The patient did well postoperatively and was discharged on the same operative day. There were no postoperative complications at 2 months follow-up. Conclusion  Cholecystectomy performed through laparoscopic incisions placed within the umbilicus was technically feasible and safe in our patient. Development of advanced flexible instrumentation and visualization platforms may facilitate this new operative approach. Further advantages of NOTUS cholecystectomy compared to conventional laparoscopic cholecystectomy will ultimately require a randomized clinical trial.     

Laparoscopic Liver Resection in Patients with a History of Upper Abdominal Surgery

Background  

The liver is the organ where tumors most frequently metastasize. Hepatic recurrence after resection of hepatocellular carcinoma also occasionally occurs. With the increasing use of laparoscopic surgery for hepatic tumors, there may be a high probability that laparoscopic liver resection can be performed in patients with a surgical history. The purpose of this study was to assess the feasibility and clinical outcomes of laparoscopic liver resection in patients a history of upper abdominal surgery.     

Factors Influencing the Respiratory Capacity after Upper Abdominal Surgery

The analgesic requirement and some factors influencing the respiratory capacity after upper abdominal surgery were studied during the first 2 days postoperatively in 417 patients, aged 17 to 84 years, undergoing surgery in the upper part of the abdomen. The operations were cholecystectomy or choledocholithotomy through a subcostal incision, partial gastric resection, repair of a diaphragmatic hernia or vagotomy through a midline incision. Pain relief was achieved in a random order either by intercostal block (i.c.b.) and centrally acting analgesics on demand, or by centrally acting analgesics alone. The analgesic demand was recorded, and the respiratory capacity was monitored by the peak expiratory flow rate (PEF). A smaller analgesic requirement and a smaller change in PEF were found after cholecystectomy than after any other kind of surgery. The demand for analgesics was age-dependent, and patients under 60 years of age demanded more than those aged 60 years and older. Bilateral i.c.b. given after surgery through a midline incision had few advantages, but unilateral i.c.b. following cholecystectomy and choledocholithotomy with a subcostal incision had positive effects. Thus it decreased the demand for centrally acting analgesics and resulted in higher PEF values than without i.c.b. for cholecystectomy during the period of effective nerve block and for choledocholithotomy for 2 whole days postoperatively. Smokers seemed to benefit from i.c.b. for 2 postoperative days. The reduction of PEF after cholecystectomy also seemed to be related to the duration of treatment with centrally acting analgesics.     

腹腔镜胆囊切除术后腹腔内出血的护理

11例腹腔镜胆囊切除术（LC）后病人发生腹腔内出血，其中8例再次手术止血，3例保守治疗。结果病人均痊愈出院。提示LC术后密切观察病人腹部体征、腹腔引流液状况，及早发现腹腔内出血、及时处理，是保证病人获得良好预后的关键。     

腹腔镜胆囊切除联合手术69例

目的探讨腹腔镜胆囊切除(Iapamscopic cholecystectomy，LC)联合手术在微创外科中的应用价值。方法同顾性分析69例慢性胆囊炎合并腹腔其他疾病联合切除术，其中LC联合阑尾切除术28例、肝囊肿开窗术8例、精索静脉曲张高位结扎术5例、腹股沟斜疝修补4例、肠粘连松解术3例、子宫次全切除12例、卵巢囊肿剥除术8例及右侧肾上腺肿物摘除术1例。结果69例手术均获得成功，无一例中转开腹，无相关并发症发生。结论LC联合手术在同一麻醉下完成两种以上手术，创伤小，花费少，住院时间短，病人痛苦少，充分体现微创外科的优越性，值得推广。     

Postoperative Pulmonary Function in Obese Patients after Upper Abdominal Surgery

The pulmonary course after jejuno-ileal by-pass operation in six massively obese patients (mean weight 130.2 kg) was followed for the first 5 postoperative days by means of arterial blood gas analysis and measurements of forced vital capacity (FVC), forced expired volume in the first second (FEV_1.0) and peak expiratory flow rate (PEFR). The patients were extubated in the operating room and were breathing spontaneously in the postoperative period. Pa_o2 and FVC reached their minimum values in the first 24 postoperative hours (respectively, 74% and 45% of their preoperative values), but were almost restored in 5 days. PEFR had at this time reached 77% of its preoperative value. FEV_1.0% (FEV_1.0 in per cent of FVC) did not change from the pre- to the postoperative period, but remained about 70%.