腹腔镜胆囊切除术中转开腹原因分析

目的 探讨腹腔镜胆囊切除术(LC)中转开腹的原因。方法 回顾性分析1998年4月～2002年3月本院LC术中转开腹病例的临床资料。结果 1368例LC中，中转开腹60例，中转率4．39％。中转开腹的原因：腹腔内及Calot三角粘连17例，急性胆囊炎或急性胆囊炎恢复期14例，胆囊癌2例，胆肠内瘘5例，胆总管结石2例，萎缩性胆囊炎6例，出血2例，胆道损伤2例，Minizi综合征2例，胆漏1例，黄色肉芽肿性胆囊炎1例，其它原因6例。结论 Colat三角解剖不清是LC中转开腹的主要原因，也与手术的技术水平和经验有关。     

Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data

Background

This study presents preliminary data from a prospective randomized multicenter, single-blinded trial of single-incision laparoscopic cholecystectomy (SILC) versus standard laparoscopic cholecystectomy (4PLC).

Methods

Patients with symptomatic gallstones, polyps, or biliary dyskinesia (ejection fraction <30%) were randomized to SILC or 4PLC. Data included operative time, estimated blood loss, length of skin and fascial incisions, complications, pain, satisfaction and cosmetic scoring, and conversion.

Results

Operating room time was longer with SILC (n = 50) versus 4PLC (n = 33). No differences were seen in blood loss, complications, or pain scores. Body image scores and cosmetic scores at 1, 2, 4, and 12 weeks were significantly higher for SILC. Satisfaction scores, however, were similar.

Conclusions

Preliminary results from this prospective trial showed SILC to be safe compared with 4PLC although operative times were longer. Cosmetic scores were higher for SILS compared with 4PLC. Satisfaction scores were similar although both groups reported a significantly higher preference towards SILC.     

腹腔镜与开腹胆囊切除术后胃肠动力恢复的对比研究

目的 探讨腹腔镜胆囊切除与开腹胆囊切除术后胃肠动力恢复情况。方法 通过测定血浆胃动素,血清胃泌素,胃电图振幅,频率及术后肠鸣音恢复时间,肛门排气时间等几项指标联合观察了３０例腹腔镜胆囊切除患者及１８例开腹胆囊切除患者。结果 腹腔镜胆囊切除术组患者手术前后胃动素,胃泌素,胃电图振幅,频率的差异无显著意义,开腹胆囊切除术后第１,２天胃动素,胃泌素,胃电图振幅,频率与术胶及腹腔镜胆囊切除术组相比差异有显     

新型经脐入路腹腔镜胆囊切除术

目的：探讨经脐双套管腹腔镜胆囊切除术的可行性,并与经脐单套管三通道腹腔镜胆囊切除术进行比较。方法：根据手术方法,将患者分成经脐单套管三通道腹腔镜胆囊切除组（12例）和经脐双套管腹腔镜胆囊切除组（17例）,比较两组在手术时间、手术并发症、术后24h使用镇痛剂例数及术后住院时间等情况。结果：29例手术全部成功,无并发症发生。经脐单套管三通道组手术时间90～150min,平均（120．25±18．97）min,明显高于经脐双套管组手术时间20～50min,平均（35．71±9．74）min,差异有统计学意义（P〈0．05）;经脐单套管三通道组术后24h使用镇痛剂例数显著高于经脐双套管组（P〈0．05）;两组在术后住院时间上无统计学差异（P〉0．05）。结论：与经脐单套管三通道组相比,经脐双套管技术在腹腔镜胆囊切除术的临床应用中更具实用性。     

腹腔镜与开腹胆囊切除胃肠压力变化的临床研究

目的 :从胃肠道压力变化的角度探讨腹腔镜与开腹胆囊切除对胃肠运动功能的影响。方法 :腹腔镜胆囊切除 30例 (男 6例 ,女 2 4例 ,4 7± 4岁 ) ,开腹胆囊切除 30例 (男 9例 ,女 2 1例 ,4 7± 7岁 ) ,分别于手术前 1d行胃电图描记 ,记录术后 3、2 4、4 8、72h胃电图及监测胃窦、十二指肠和空肠压力 (移行性运动复合波 ,MMCⅢ )。结果 :(1)手术前腹腔镜和开腹胆囊切除患者胃电频率差异无显著性 (P >0 .0 5 ) ;(2 )腹腔镜胆囊切除组术后 3、2 4h正常波所占百分比低于术前 ,但差异无显著性 (P >0 .0 5 ) ,术后 4 8h恢复正常 ;(3)开腹胆囊切除组术后起 3h正常波所占百分比明显低于术前 ,差异有显著性 (P <0 .0 1) ,术后 2 4、4 8h正常波的百分比与术前差异无显著性 ,术后 72h恢复正常 ;(4) 2组患者术后胃窦、十二指肠及空肠压力低于健康人群 (P<0 .0 5 ) ;(5 ) 2组胃窦部收缩压力及收缩曲线下面积术后第 1、2、3d较术后 3h明显升高 (P <0 .0 5 ) ,且随时间延长有逐渐增大的趋势 ,腹腔镜组术后 72h恢复正常 ,十二指肠及空肠术后 3d内无明显变化 ;(6 ) 2组间胃电频率 ,胃窦部、十二指肠及空肠压力变化差异无显著性 (P >0 .0 5 ) ,但显示有差别。结论 :腹腔镜与开腹胆囊切除术均可引起胃电频率及胃肠压力变化 ,开     

腹腔镜胆囊切除术并发症6例分析

目的 :探讨腹腔镜胆囊切除术 (LC)中发生并发症的原因及防治办法。方法 :回顾分析LC并发症 6例的临床资料。结果 :胆囊动脉出血 3例 ,胆瘘 3例 ,胆汁性腹膜炎 1例 ,均经治疗痊愈出院。结论 :在开展腹腔镜初期应严格掌握适应证 ,规范处理Calot三角 ,耐心、细致 ,顺逆结合 ,选择性地腹腔引流 ,可减少并发症的发生     

腹腔镜胆囊切除术对细胞因子、内皮素和C反应蛋白水平的影响

目的:探讨开腹与腹腔镜胆囊切除术(LC)2种方法对胆囊疾病患者血中细胞因子、内皮素和C反应蛋白的影响,比较两种方法对机体损伤的程度及安全性。方法:选择行剖腹胆囊切除术(OC)患者50例,LC患者50例,分别于术前和术后抽取静脉血检测IL-2、IL-6、NK细胞活性、CD4/CD8、内皮素、C反应蛋白含量并进行比较。结果:OC组IL-2和NK细胞活性术后较术前下降(P<0.05),IL-6术后较术前明显上升(P<0.01)。IL-6术后OC组较LC组上升(P<0.05)。OC组IL-2术后较LC组降低(P<0.05)。CD4/CD8未发现明显变化。OC组血中内皮素术后含量明显高于LC组患者(P<0.01),C反应蛋白于术后亦高于LC组。结论:研究表明LC损伤小,是一种安全可靠的手术方式。     

Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy

In an attempt to quantify the difference in tissue damage between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), we have compared in a prospective manner the pre- and postoperative concentrations of serum C-reactive protein (CRP) in 17 patients undergoing LC and 13 patients undergoing OC. In addition, we measured the pre- and postoperative white blood cell counts (WBC), the postoperative body temperature, and the postoperative duration of hospitalization. There were no differences in the preoperative serum CRP concentrations—5.9±2.62 mg/l (mean±SD) for the LC group and 6.12±2.38 mg/l for the OC group.Serum CRP rose markedly following OC compared to that of patients who underwent LC (128.6±45.1 mg/l vs 26.8±10.5 mg/l) (P<0.001). There were also significant differences in the postoperative WBC count (14,000±2,900 cells for the OC group vs 10,600±3,000 cells for the LC group), the postoperative body temperature (37.5±0.3°C vs 37.0±0.3°C), and the postoperative hospital stay (5.5±1.5 days vs 1.9±0.9 days). There was no correlation between serum CRP concentrations and the other postoperative parameters.These results provide us with biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.     

腹腔镜胆囊切除术对机体免疫球蛋白、补体及CRP的影响

目的 :研究腹腔镜胆囊切除术 (LC)和开腹胆囊切除术 (OC)对机体免疫功能的影响。方法 :检测LC 2 0例和OC 18例患者入院次日、术后 2 4h和 4 8h的IgG、IgA、IgM和补体C3、C4 及C 反应蛋白质 (CRP)含量并进行对照研究。结果 :LC组免疫球蛋白及补体水平手术前后无变化 ,OC组术后血清IgG和C3低于术前水平 ,两组间差异无显著性 (P >0 0 5 ) ,但OC组术后下降幅度比LC组大 ,两组间差异有显著性 (P <0 0 5 )。两组术后CRP均明显升高 ,而OC组术后改变明显高于LC组 ,两组间差异有显著性 (P <0 0 1)。结论 :LC和OC术后早期免疫功能均在一定程度上被抑制 ,但LC组的免疫抑制程度较OC组轻 ,恢复快 ,表明LC对机体的创伤较小 ,是微创手术     

Lung function after open versus laparoscopic cholecystectomy

Postoperative lung function and gas exchange were studied in 36 patients after cholecystectomy. Twenty-four of the patients underwent laparoscopic cholecystectomy while the remaining twelve were operated with open technique. Before surgery all patients had normal ventilatory volumes (forced vital capacity, FVC and forced expired volume in 1 s, FEV₁) and normal gas exchange. Two hours postoperativley FVC was reduced to 64±16% (P<0.05) of the preoperative level in the laparoscopic group and to 45±23% (P<0.05) after open cholecystecomy. On the first postoperative day FVC was virtually normal in the laparoscopic patients (77±17% of preoperative level, NS), whereas the open surgery patients still had a decreased FVC (56±13% of preoperative, P<0.05). FEV₁ in the postoperative period followed the same course as FVC. Gas exchange was significantly impaired in the early postoperative period in all patients but no difference between the two groups was found. Two hours postoperatively Pao₂ was reduced to 85% (P<0.05) of preoperative value and Paco₂ had increased by 0.5 kPa (p<0.05). The alveolo-arterial oxygen tension difference (PA-ao₂) had increased by approximately 45% to a mean of 3.7 kPa (P<0.05). On the first postoperative day gas exchange was still significantly impaired in the open surgery patients. Atelectasis detected by computed X-ray tomography of the lungs were found in both groups. However, the amount of atelectasis tended to be smaller in the laparoscopic group than in the open surgery patients. In summary, cholecystectomy irrespective of whether it was performed by open or laparoscopic technique was followed by deterioration in ventilatory function and gas exchange. However, the magnitude of this impairment was less pronounced in laparoscopic cholecystectomy patients than in the open surgery patients which may suggest that this minimal invasive procedure is favourable with respect to postoperative lung function.     

急性胆囊炎腹腔镜手术时机的选择

目的 :探讨腹腔镜治疗急性胆囊炎的最佳时机。方法 :14 1例急性胆囊炎患者。按照手术时患者的发病时间分为 2组 ,早期手术组 88例 ,起病 72h以内行腹腔镜胆囊切除术 (LC) ;晚期手术组 5 3例 ,起病72h后行LC。结果 :早期手术组 4例发生并发症 (4 5 5 % ) ,5例中转开腹 (5 6 8% )。晚期手术组 12例发生并发症 (2 2 6 4% ) ,9例中转开腹 (16 98% )。对比 2组并发症的发生率及术后恢复时间 ,早期手术组缩短了住院时间 ,节省了医疗费用。并且早期手术组无 1例发生严重并发症。结论 :急性胆囊炎一经诊断明确应立即行LC ,在炎症、粘连坏疽出现前行LC治疗急性胆囊炎是安全有效的     

传统术式,腹腔镜与小切口胆囊切除术疗效对比研究

为探讨小切口胆囊切除术的临床价值,作者就传统开腹胆囊切除术３００例（Ａ组）、腹腔镜胆囊切除术３００例（Ｂ组）、与小切口胆囊切除术３００例（Ｃ组）的手术时间、术中出血量、并发症、术后胃肠功能恢复时间、输液天数和住院天数等项指标进行了对比。结果显示：Ａ组手术时间、术中出血量、输液天数、胃肠功能恢复时间及住院天数比Ｂ、Ｃ两组长（Ｐ＜０．０５）。Ｂ、Ｃ两组的手术时间、术中出血量、胃肠功能恢复时间、输液天数及住院时间相近似。并发症发生率Ａ组（０．３３％）比Ｂ组（１．６６％）低,而Ｃ组未出现１例并发症（Ｐ＜０．０５）。综合三组疗效对比,Ｃ组明显优于Ａ、Ｂ两组。     

Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy

Purpose

The natural progression of minimal access surgery is to perform the same technical operation with minimal or no evidence of scarring. In children, small case series of single-incision laparoscopic cholecystectomy suggests that the operation is feasible; however, no comparison has been made to traditional, multiport laparoscopic cholecystectomy in patient safety, outcomes, and cost.

Methods

A retrospective review of consecutive single-incision laparoscopic cholecystectomies in children was performed from January 2009 to November 2010. Demographics and outcome measures were recorded, including operative time, operative costs, length of stay, need for intravenous analgesia, and operative complications. A concurrent group of pediatric patients undergoing traditional, multiport laparoscopic cholecystectomy was used for comparison.

Results

A total of 69 pediatric laparoscopic cholecystectomies were performed from January 2009 to October 2010. Forty-two patients with a mean age of 14.7 years (range, 5.9-18.9 years) underwent attempted single-incision laparoscopic cholecystectomy, and 27 patients with a mean age of 15 years (range, 2.8-19.4 years) underwent multiport laparoscopic cholecystectomy. Mean operative time (68 vs 64.5 minutes; P, not significant [NS]), length of stay (1.45 vs 1.19 days; P, NS), and doses of intravenous analgesia (1.7 vs 2; P, NS) were not significantly different for patients undergoing single-incision or multiport laparoscopic cholecystectomy, respectively. Two patients (5%) undergoing the single-incision approach required 1 additional port be placed to complete the operation. In addition, there was no significant difference in operative costs between the single-incision and multiport approach ($7766 vs $8383; P, NS).

Conclusion

Single-incision laparoscopic cholecystectomy is safe and effective in the pediatric population. It can be performed with the same technical exposure and outcomes as multiport laparoscopy, with the added benefit of little to no scarring and no increase in cost.     

The cost of laparoscopic versus open cholecystectomy in a community hospital

This retrospective study reviewed the hospital and professional costs, charges, and reimbursements for laparoscopic cholecystectomy (lap chole) and open cholecystectomy (open chole) and compared the two procedures. There was no significant difference in hospital costs between lap and open chole procedures; however, there were marked differences in the categories of costs for each procedure. The mean total (hospital and professional) charge was 8% greater for lap chole. The mean total (hospital and professional) reimbursement for patients with private insurance was 23% greater for lap chole, but no significant difference was seen for patients on Medicare or Medicaid. Lap chole patients returned to work 11 days sooner than open chole patients; this can result in a 69% decrease in short-term disability costs to employers. The clinical variables that significantly affect total charges and reimbursement are discussed.     

腹腔镜下同时完成胆囊、子宫切除术6例报告

目的 :探讨电视腹腔镜同时完成胆囊、子宫切除术的可行性及手术并发症的预防。方法 :回顾分析 6例的手术过程及随访结果。结果 :6例中 4例一次完成胆囊、子宫切除术 ,平均手术时间 16 0min ,胆囊切除术平均 4 0min ,子宫切除术平均 12 0min ;1例腹腔镜下切除子宫 ,开腹完成胆囊手术 ;1例腹腔镜下完成胆囊手术 ,开腹完成子宫手术。结论 :腹腔镜下同时完成两种手术不增加手术危险性及并发症及术后病率。同时完成两种手术减少了患者的痛苦及手术费用 ,术后患者康复满意     

老年患者腹腔镜胆囊切除术即刻中转开腹的临床体会

目的:探讨老年患者腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）即刻中转开腹的原因及预防措施.方法:回顾分析1993年1月至2009年1月3 212例老年患者LC术中128例即刻中转开腹的临床资料.结果:128例中转开腹,中转率3.99％.127例痊愈.1例于术后第3天死于应激性溃疡...     

腹腔镜胆囊切除术中的困难因素及对策

目的 :探讨腹腔镜胆囊切除术 (LC)术中的困难因素及对策。方法 :回顾分析 12 8例LC患者的临床资料。结果 :12 8例中中转开腹 6例 ,手术困难 4 9例 ,术后毛细胆管漏 1例。结论 :LC术中有困难因素者占 38 3% ,熟悉术中困难因素及对策 ,熟练掌握手术操作技能 ,可减少并发症的发生并降低中转开腹率     

腹腔镜胆囊切除术中转开腹的影响因素

目的：分析腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中转开腹的影响因素并探讨其防治措施。方法：对2000年1月至2006年1月1 170例LC术中97例（8.29%）中转开腹情况进行回顾性分析。结果：急性炎症期胆囊炎51例,占中转开腹的52.6%;术中出血25例（25.8%）;怀疑胆总管结石12例（12.4%）;胆囊癌5例（5.15%）;过度肥胖患者4例（4.12%）,开腹手术均获成功,均痊愈出院。结论：熟悉胆道系统解剖及变异、熟练的腹腔镜操作技术是减少LC中转开腹的关键,但适时中转开腹是防止LC严重并发症的最佳选择。     

Quality-of-life outcomes with laparoscopic vs open cholecystectomy

Background: The purpose of this article is to describe our experience using laparoscopy in the management of emergent and acute abdominal conditions. Methods: Between March 1997 and November 2001, 277 consecutive minimally invasive procedures were performed for various nontrauma surgical emergencies. The indications for operation were nonspecific abdominal pain in 129 cases (46%), peritonitis in 64 cases (23%), small bowel obstruction in 52 cases (19%), complications after previous surgery or invasive procedures in 24 cases (9%), and sepsis of unknown origin in 8 cases (3%). Results: Laparoscopy obtained a correct diagnosis in 98.6% of the cases. In 207 patients (75%), the procedure was completed laparoscopically. An additional 35 patients (12.5%) required a target incision. The remaining 35 patients (12.5%) underwent formal laparotomy. The morbidity rate was 5.8%. No laparoscopy-related mortality was observed. Conclusions: For patients with abdominal emergencies, the laparoscopic approach provides diagnostic accuracy and therapeutic options, avoids extensive preoperative studies, averts delays in operative intervention, and appears to reduce morbidity. Preliminary results presented at the 9th European Association for Endoscopic Surgery (E.A.E.S.) Annual Congress, Maastricht the Netherlands, 13–16 June 2001     

腹腔镜胆囊切除术中出血的防治

目的 :研究腹腔镜胆囊切除术 (LC)中防治出血的措施。方法 :回顾分析 32 6例LC术中出血的原因。结果 :患者平均出血量约 30ml。无因出血中转开腹及术中术后输血者。结论 :合理选择手术适应证 ,确定手术时机 ,术中正确识别与处理变异的胆囊动脉 ,动作轻柔细致 ,冷静处理术中出血 ,能减少出血