腹腔镜胆囊切除术后残余胆囊结石的外科处理

目的探讨腹腔镜胆囊切除术后残余胆囊结石的治疗和预防方法。方法回顾分析16例腹腔镜胆囊切除术后残余胆囊结石患者的诊治经过。结果结合彩超、MRCP、ERCP等检查方法均可确定诊断,通过开腹或腹腔镜下残余胆囊切除术,术后患者临床症状均有效缓解,无严重并发症。结论对于残余胆囊应该重视初次手术中的预防。腹腔镜下残余胆囊切除术安全可靠。当合并胆总管结石时,可联合内镜和腹腔镜分次治疗。术中胆道造影或胆道镜检查可增加手术安全。     

腹腔镜胆囊切除术后残余胆囊的腹腔镜再手术治疗体会

目的:探讨残余胆囊再次行腹腔镜切除术的可行性及手术技巧。方法:回顾分析2010年6月至2014年8月收集的18例病例,其中2例合并胆总管结石。患者均经历一次腹腔镜胆囊切除术,术后出现残余胆囊结石,并出现胆囊炎症状,再次行腹腔镜残余胆囊切除术(2例胆总管结石同时行胆总管切开取石术)。结果:18例均顺利行腹腔镜残余胆囊切除术,手术时间平均(55.3±0.6)min,术中出血量平均(35.5±0.3)ml,患者均于术后次日下床并进食低脂流食,术后恢复良好,患者术前主诉的症状均消失,平均住院(3.8±0.3)d,随访10例患者1~6个月,无胆漏、黄疸等并发症发生。结论:腹腔镜手术用于腹腔镜胆囊切除术后残余胆囊结石伴胆囊炎是安全、有效的治疗方法,值得推广应用。     

青南高原地区肝胆结石患者外科手术治疗500例临床分析

目的:探讨青南高原地区胆囊结石患者发病机制特点和手术治疗方法及临床效果.方法:选取来自青南高原地区的胆囊结石患者500例作为临床研究分析对象,均采用手术治疗,其中2 50例采用小切口开放性胆囊切除术,250例采用腹腔镜胆囊切除术,比较两组患者疗效.结果:腹腔镜组患者在手术操作时间、术中出血量、术后下床活动时间、住院时间及术后并发症等方面显著优于小切口组(P＜0.01).结论:腹腔镜胆囊切除术治疗肝胆结石对于来自青南高原地区胆囊结石患者疗效肯定.     

腹腔镜胆囊切除术在肝硬化患者中的应用

我院于1999年7月～2002年7月行腹腔镜胆囊切除术(LC组)的肝硬化患者共33例,同期行开腹胆囊切除术(OC组)的肝硬化患者有25例。现予回顾总结,旨在探讨对伴有肝硬化的胆囊结石或胆囊息肉患者进行腹腔镜胆囊切除术的特点和优点。1 临床资料1.1 一般资料 1999年7月～2002年7月我院共对58例肝硬化合并胆囊结石或胆囊息肉的患者实施了胆囊切除术,其中33例为腹腔镜切除(LC组):男,19例,女,14例;平均年龄     

门静脉高压症患者合并胆囊结石的处理体会

目的 探讨门静脉高压症患者合并胆囊结石的手术处理.方法 对46例门静脉高压症合并胆囊结石患者的临床资料进行回顾性分析.结果 46例中,腹腔镜胆囊切除术18例,开腹胆囊切除术16例,胆囊部分切除术12例,均治愈.结论 合理的选择术式和有效的围手术期处理对于门静脉高压症合并胆囊结石的处理极为重要的.     

腹腔镜与开腹胆囊切除术对老年患者术后应激反应和疲劳综合征影响的对比研究

目的:对比分析腹腔镜与开腹胆囊切除术时老年患者术后应激反应和术后疲劳综合征的影响,为腹腔镜胆囊切除术治疗胆囊结石的老年患者是否具有优越性提供客观依据.方法:筛选符合适应证的胆囊结石患者40例,随机分为腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）组和开腹胆囊切除术(open chol...     

血友病合并胆囊结石行腹腔镜胆囊切除术探讨

目的 探讨血友病患者合并胆囊结石行腹腔镜胆囊切除术的可行性和止血处理措施.方法 采用回顾性对照研究方法,对比分析18例血友病合并胆囊结石患者行腹腔镜胆囊切除术(血友病组)与312例单纯胆囊结石患者行腹腔镜胆囊切除术(单纯组)的临床资料,观察两组患者手术时间、术中出血量、术后平均住院时间及中转开腹情况.结果 血友病组患者的手术时间、术中出血量、术后平均住院时间与单纯组患者均无统计学差异(P>0.05).结论 血友病患者合并胆囊结石行腹腔镜胆囊切除术是安全有效的.严格掌握手术适应证、围手术期凝血功能纠正、熟练的手术技巧加上可靠的止血方法,是手术成功的关键.     

腹腔镜治疗复杂性胆囊结石的临床分析

目的 评估腹腔镜胆囊切除术治疗复杂性胆囊结石的疗效,总结手术操作的技巧和经验.方法 回顾分析3年间腹腔镜手术治疗256例复杂性胆囊结石患者的临床资料.结果 所有患者均痊愈出院,无中转开腹手术及手术死亡.结论掌握手术适应证及处理各种复杂情况的操作技巧对腹腔镜胆囊切除术治疗复杂性胆囊结石大有帮助.     

腹腔镜胆囊切除术围术期临床护理路径效果观察

目的观察腹腔镜胆囊切除术(LC)围手术期临床护理路径的效果。方法随机将424例接受LC的胆囊结石患者分为2组,各212例。对照组给予常规护理,观察组给予临床护理路径。结果观察组患者的住院时间、下床活动时间、禁食时间、住院费用、并发症发生率及护理工作满意度均优于对照组,差异有统计学意义(P0.05)。结论对接受LC的胆囊结石患者围术期采用临床护理路径,有利于降低并发症发生率,缩短康复进程,减少医疗费用,提高护理工作满意度。     

腹腔镜胆囊切除联合胆总管探查术治疗胆囊结石并胆总管结石的临床研究

目的:探讨腹腔镜胆囊切除联合胆总管探查术治疗胆囊结石并胆总管结石的临床价值.方法:回顾分析2006年6月至2011年5月256例胆囊结石并胆总管结石患者的临床资料,均于腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)中切开胆总管,行纤维胆道镜胆总管探查取石.结果:256例手术均获成功...     

Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway

OBJECTIVE: To determine the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center, and to assess the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy is reported to be safe for patients and acceptable as an outpatient procedure. Whether this experience can be translated to an academic health center or larger hospital is uncertain. Clinical pathways guide the care of specific patient populations with the goal of enhancing patient care while optimizing resource utilization. The effectiveness of these pathways in achieving their goals is not well studied. METHODS: During a 12-month period beginning April 1, 1999, all patients eligible for an elective LC (n = 177) participated in a clinical pathway developed to transition LC to an outpatient procedure. These were compared with all patients undergoing elective LC (n = 208) in the 15 months immediately before pathway implementation. Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared. Average length of stay and total hospital costs were calculated and compared. RESULTS: After pathway implementation, the proportion of same-day discharges increased significantly, from 21% to 72%. Unplanned postoperative admissions decreased as experience with the pathway increased. Patient characteristics, need for readmission, complications, and deaths were not different between the groups. Patients surveyed were highly satisfied with their care. Resource utilization declined, resulting in more available inpatient beds and substantial cost savings. CONCLUSIONS: Implementation of a clinical pathway for outpatient LC was successful, safe, and satisfying for patients. Converting LC to an outpatient procedure resulted in a significant reduction in medical resource use, including a decreased length of stay and total cost of care.     

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??Clinical pathway for the surgical management of thyroid disease ZHANG Hao. Department of General Surgery, the First Hospital of China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao??E-mail: haozhang@mail.cmu.edu.cn
Abstract Clinical pathway is a new mode for monopathy quality management and occupational benchmarking of medical service developed in recent years. Clinical pathway scale for surgeon, clinical pathway notice for patients and clinical pathway flow chart for surgeon and so on were used to management of patients performed thyroid surgery tentatively at the First Hospital of China Medical University. Clinical pathway implementation can well the standard medical behavior, shorten the hospitalization time, reduce the medical costs, guarantee the medical quality, improve the patient satisfaction and achieve good economic and social efficiency. The use of clinical pathway specifically designed for the management of the operation for thyroid disease will result in the improved outcomes of patients.     

子宫平滑肌瘤手术患者实施临床路径管理的探讨

目的 探讨子宫平滑肌瘤手术患者临床路径的应用效果.方法 将50例子宫平滑肌瘤手术患者作为实验组,实施临床路径的医疗护理.对照100例采用传统的医疗护理方法的对照组患者.结果 实验组的手术等候时间、住院日较对照组短,平均住院费用较对照组低(P值均<0.01).结论 实施临床路径管理,可以规范医疗行为,保证医疗质量,提高患者满意度,增加医院服务人次,减轻患者经济负担,提高医院的社会效益和经济效益     

肺癌筛查的研究进展

肺癌是目前世界上发病率最高的恶性肿瘤之一,而其每年死亡人数已居所有恶性肿瘤之首。其中80%的患者就诊时已属晚期,丧失了手术的机会。在所有手术患者中,TNM分期较早的患者,其5年死亡率远远低于晚期患者。随着医疗设备的改进及其体检人群的增加,较多肺部小结节患者被发现,使用电子胸腔镜进行有限地肺切除,包括肺楔形切除或肺段切除等,使得这部分患者以较小的治疗代价取得了不亚于传统肺叶切除术的良好效果;同时其生存质量远远优于后者。肺癌筛查能更多地诊断早期癌变,使患者能够在早期就得到合理地诊治,这可以大大降低治疗成本及病死率,以最小的经济及医疗代价取得最大的治疗收益。本文结合一些肺癌筛查指南及试验研究,通过对肺癌筛查的必要性、高危人群、评价标准、筛查方法等的讨论,以期得到合理的筛查策略,能为临床肺癌筛查工作提供较为可行的参考。     

输尿管结石的临床路径实施与效果评价

目的研究临床路径在输尿管结石治疗中的实施情况并评价其效果。方法将2010年11月至2011年10月期间我科室收治的285例第一诊断为输尿管结石（单侧）并适合行输尿管镜碎石取石术的患者利用简单随机分组的方法分为临床路径组和对照组。其中入临床路径组151例,对照组134例,对比分析两组患者平均住院时间、住院费用、临床疗效、患者认知度和满意度以及医护人员对临床路径实施效果调查。结果临床路径组在疗效上与对照组无显著差异,而在平均住院天数及住院费用显著低于对照组（P〈0.05）;临床路径组患者对疾病的认识程度和满意度调查亦显著高于对照组（P〈0.05）;多数医护人员认为临床路径可有效增进医患沟通、提高医疗质量。结论临床路径可有效规范输尿管结石的手术治疗,提高效率,值得深入实施和推广。     

临床路径管理模式下成人腹股沟疝日间手术应用研究

目的探讨成人腹股沟疝日间手术临床路径的实施及应用效果。 方法收集2014年1月至2016年6月聊城市人民医院收治的120例成人单侧腹股沟疝患者的临床资料，按照患者意愿分为临床路径组（观察组）56例和住院手术组（对照组）64例，分析两组患者住院时间、住院费用、手术效果及术后并发症等情况，并进一步做成本-效果分析。 结果两组患者的手术时间、术中出血量、术后并发症发生率等指标比较，差异无统计学意义（t=0.397、0.790，P=0.823、0.430；χ²=0.250，P=0.617）；观察组患者的住院时间及住院总费用均显著低于对照组（t=10.851、6.755，均P<0.001）。成本-效果分析显示观察组患者每减少1例术后并发症，需要消耗的社会成本均低于对照组。 结论应用临床路径管理模式能够显著降低成人腹股沟疝患者住院医疗成本，在提高效率的同时最大程度地降低医疗风险，保障日间手术的安全，提高医疗质量。     

腹腔镜胆囊切除术与直视微创胆囊切除术治疗胆囊疾患比较分析

目的:比较分析腹腔镜胆囊切除术(LC)与直视微创胆囊切除术(MPC)治疗胆囊疾患的疗效。方法:2002年以来对228例患者分别行LC及MPC。对两组术后疗效、手术时间、住院时间、恢复工作时间、并发症等进行全面分析。结果:随访2~18个月,两组患者胆囊疾病引起的临床症状消失,效果满意。在手术时间安全性、术后并发症等方面,LC明显优于MPC(P<0.05)。结论:从手术安全性、减少术中、术后并发症,减轻患者痛苦,提高患者生存质量考虑,LC是治疗胆囊疾患的首选术式。     

Clinical pathways. Implementation in a urological department

BACKGROUND: Clinical pathways are directions for standardised treatment processes for different diseases or procedures in a hospital. These pathways are developed within a team of several professions and are used as order and procedure sheets. Experiences with this element of quality management are limited in Germany. METHODS: The development and the implementation process of 15 pathways in a urological department are described. A clinical pathway for female incontinence surgery (suburethral tape) is presented as an example. The effects of the pathways are evaluated on a routine basis. RESULTS: Seventy-two percent of the patients were treated according to a clinical pathway. The advantages of clinical pathways are a better structuring and transparency of medical processes, a reduction of documentation, improvements in medical education and savings in time, hospital stay of the patients and costs. Expenses for pharmaceuticals were significantly reduced in connection with development of the pathways. CONCLUSIONS: The implementation of clinical pathways is a complex but rewarding project. It can be expected that clinical pathways will be rapidly distributed in the near future and that they will contribute to improvements of health care quality.     

椎间盘镜治疗腰椎间盘突出症的临床路径实施效果分析

目的分析椎间盘镜治疗腰椎间盘突出症的临床路径的实施效果和变异情况。方法本研究采用历史对照设计类型,实验组应用医院自行设计的临床路径诊疗模式,对照组采用传统诊疗模式,测量指标主要包括住院天数、住院费用、患者满意度和JOA评分,分析方法包括t检验和χ2检验。结果与非临床路径患者比较,进入临床路径患者总住院天数、手术前后住院天数、总住院费用、手术前后及手术日住院费均显著减少,患者满意度和JOA评分改善率显著提高。26例患者发生了临床路径变异。结论临床路径的实施能有效降低住院天数和住院费用,提高医疗质量和患者满意度,应重视记录、分析和处理临床路径变异。     

Laparoscopic cholecystectomy in 226 cirrhotic patients. Experience of a single center in Taiwan

Background: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions. However, cirrhosis and portal hypertension have been considered relative or absolute contraindications to LC. This study aimed to assess the safety of LC in cirrhotic patients. Method: The medical records of 226 cirrhotic patients with gallbladder lesions who had undergone LC from 1991 to 2000 were reviewed, including demographics, severity of cirrhosis, laboratory data, operative morbidity, operative mortality, and hospital stay. Furthermore, the clinical features and outcomes of 4030 patients with gallbladder lesions without cirrhosis that had undergone LC were also summarized for comparison. Results: Of 4256 patients with gallbladder lesions that had undergone LC, 226 (5.6%) had cirrhotic livers. The cirrhotic group patients clearly exhibited the trends of older age, worse liver function, higher blood loss, and higher mortality compared to the noncirrhotic group patients. Conclusions: This study presents the clinical features and outcomes of 226 cirrhotic patients who underwent LC. LC, once considered contraindicated in patients with cirrhosis, is a feasible procedure for most Child's A and B patients with cholecystolithiasis. Minor morbidity, an acceptable conversion rate, and shorter hospital stay can be achieved by applying LC to treat cirrhotic patients. However, appropriate preoperative preparations and meticulous operative techniques are required to reduce blood loss during laparoscopy and even mortality.