腹腔镜胆囊切除术对机体应激反应的影响

目的 研究腹腔镜手术对机体应激反应的影响.方法 选择我院2007 年9 月月至2008 年9 月间行腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)的患者共178 例,其中LC 139 例,OC 39 例.LC 按手术时间长短分为3 组:A 组手术时间≤30 min,26 例;B 组30~60 min,76 例,C 组>60 min,37 例.检测患者手术前后内皮素(ET)、超氧化物歧化酶(SOD)水平的变化,观察比较手术方式以及LC 手术时间长短对应激指标的影响.结果 譹訛LC 组术后1 d ET 明显下降(P<0.05),术后3 d 恢复至术前水平;OC 组手术前后ET 无显著变化;譺訛两组患者手术结束时SOD 活力明显低于术前水平(P<0.05),LC 组术后2 d 恢复至术前水平,OC 组术后3 d 恢复至术前水平;譻訛不同LC 手术时间组对术后各应激指标影响无统计学差异(P>0.05).结论 LC 对机体应激反应的影响小于OC.     

腹腔镜胆道探查取石术与传统开放手术对机体创伤和免疫影响的研究

目的:比较腹腔镜胆道探查取石术与传统开放手术对机体创伤及免疫的影响。方法:将胆道结石患者40例分成两组,腹腔镜组20例,传统手术组20例,两组男女各10例,47～72岁。由同一手术组施术。分别于术前1d和术后3d及7d抽取外周静脉血监测相应的实验指标,同时监测两组临床观察指标。结果:创伤指标(WBC,NE%,L%,血糖,CRP,TNF-α,IL-6),免疫学检测指标(IgG,IgA,IgM,C3,C4,CD3+,CD4+,CD8+,NK),临床指标(手术时间、术中出血量、术后疼痛评分、SIRS发生和持续时间、术后通气时间、术后并发症、住院时间)腹腔镜组均优于传统手术组。结论:腹腔镜胆道探查取石术与传统开放手术相比,手术切口小、术中出血少、术后肠道功能恢复快、疼痛轻、住院时间短、应激指标升高与免疫指标减少较低,且术后恢复较快,对机体免疫功能和应激反应影响小,能更好的减少机体创伤,保护机体免疫功能,患者术后康复快,体现了腹腔镜胆道手术的微创性。     

腹腔镜与开腹胆囊切除术机体氧化应激反应及细胞免疫变化的比较

比较腹腔镜与开腹胆囊切除术患者机体氧化应激反应、细胞免疫水平的变化。回顾性分析2015年1月—2016年12月在本院行胆囊切除手术治疗的51例患者的临床资料。其中腹腔镜胆囊切除手术27例(腹腔镜组)、传统开腹手术24例(开腹组),比较两组患者手术前后不同时间的机体应激反应、细胞免疫水平。术后即刻腹腔镜组患者的MDA水平显著高于开腹组(P0.05)、SOD水平显著低于开腹组(P0.05);术后24 h腹腔镜组患者的MDA水平显著低于开腹组(P0.05)、SOD水平显著高于开腹组(P0.05)。术后24、72 h,腹腔镜组患者的CD3+、CD4+、CD4+/CD8+水平显著高于开腹组(P0.05);术后24 h腹腔镜组患者的RCRR显著高于开腹组(P0.05)。腹腔镜胆囊切除术后患者免疫水平、应激水平恢复速度较开腹组快速。     

腹腔镜胃癌根治术对患者围手术期免疫功能的影响

目的:研究腹腔镜胃癌根治术对患者围手术期免疫功能的影响。方法:选择2014年1月至2016年12月收治的30例腹腔镜胃癌根治术患者(腹腔镜组)与30例开腹手术患者(开腹组),测定术前及术后免疫指标,比较两组手术相关指标。结果:腹腔镜组术中出血量、术后排气时间、住院时间优于开腹组,但手术时间延长(P0.05)。术后,开腹组白细胞计数、中性粒细胞比率、C反应蛋白及血清白介素-6水平均高于术前(P0.05),但IgG含量降低(P0.05),C3水平于术后24 h下降(P0.05)。术后24 h,腹腔镜组白细胞计数、中性粒细胞比率及白细胞介素-6含量增高(P0.05),于术后72 h恢复至术前水平(P0.05);术后C反应蛋白水平增高(P0.05);白细胞计数、中性粒细胞比率及C反应蛋白的变化幅度均低于开腹组(P0.05)。结论:与开腹手术相比,腹腔镜手术治疗胃癌创伤较小,对机体免疫功能抑制较轻。     

腹腔镜胆囊切除辅助小切口胆总管探查治疗胆囊结石合并胆总管结石的临床研究

目的 探讨腹腔镜胆囊切除辅助小切口胆总管探查治疗胆囊结石合并胆总管结石的诊治经验及应用价值.方法 回顾性分析142例患者的临床资料,142例分为腹腔镜胆囊切除+小切口辅助胆总管探查术组(A组)、腹腔镜胆囊切除+胆总管探查术组(B组)和开腹手术组(C组),比较三组患者的手术时间、术中出血量、术后肠功能恢复时间、腹腔引流量、住院时间及并发症发生率.结果 A组患者手术时间与B组比较差异有统计学意义(P<0.05),肠功能恢复时间、住院时间与C组比较差异有统计学意义(P<0.05).结论 小切口辅助腹腔镜胆囊切除合并胆总管结石的治疗安全可行,但应根据情况采用个体化的治疗方法.     

血CRP、IL-6、IL-10在不同类型胆囊切除术中的变化研究

目的探讨日间腹腔镜胆囊切除术与常规胆囊切除术两种手术方法对患者血c反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介素10（IL-10）的影响,比较两种手术对患者身体的损伤程度及优越性。方法90例胆囊疾病患者随机分为两组,60例行腹腔镜胆囊切除术,30例行常规胆囊切除术。其中行腹腔镜胆囊切除术60例病例随机分为两组,30例行腹腔镜胆囊切除术30mjn内完成,30例行腹腔镜胆囊切除术在30min以上完成。比较2种术式手术时间、术前和术后及行腹腔镜胆囊切除术30min内完成和30min以上完成的血C反应蛋白（CRP）、白细胞介素6（IL-6）、白细胞介10（IL-10）的变化,术后抗生素使用率。结果腹腔镜组的手术效果明显优于对照组,血CRP、IL-6、IL-10明显低于对照组（P〈0．05）;腹腔镜手术30min内完成的手术效果明显优于腹腔镜手术30min以上,血CRP、IL-6、IL—10明显低于对照组（P〈0．05）。结论日问腹腔镜胆囊切除术是一种安全可靠的手术方法,与传统的开腹手术相比具有创伤小、出血少、术野清楚、切口美观、术后恢复快、抗生素使用率低、住院时间短等优点,将成为胆囊切除术的首选术式。     

腹腔镜经胆囊管胆道探查术治疗肝外胆管结石的疗效分析

目的探讨腹腔镜经胆囊管胆道探查术治疗肝外胆管结石的疗效。方法选取2014年2月至2017年1月在阿克苏地区第一人民医院治疗的肝外胆管结石患者140例,按治疗方式分为3组:A组接受腹腔镜胆囊切除和经胆囊管胆道探查(n=52),B组接受腹腔镜胆囊切除+胆总管切开探查+胆管一期缝合(n=46),C组接受腹腔镜胆囊切除+胆总管切开探查+T管引流(n=42),观察三组手术时间、术中出血量、腹腔引流时间、住院时间、住院费用、恢复正常生活时间及并发症发生情况,同时采用激素免疫法测定三组患者手术前后肾上腺素、皮质醇水平变化,采用酶联免疫法测定三组患者手术前后白细胞介素-6(IL-6)和C反应蛋白(CRP)水平变化。结果 C组手术时间为(120.04±12.26)min,明显长于A组和B组(P0.05);B组和C组术中出血量为(63.28±23.14)m L(62.42±21.01)m L、,明显多于A组(P0.05);A组腹腔引流时间为(3.41±0.33)d,明显短于B组和C组(P0.05);B组腹腔引流时间为(4.12±0.54)d,明显短于C组(P0.05);C组住院时间、住院费用和恢复正常生活时间分别为(7.60±1.26)d、(21 104.11±483.90)元和(38.27±1.98)d,明显多于A组和B组(P0.05);C组术后肾上腺素、皮质醇、IL-6和CRP分别为(220.32±42.06)ng/m L、(562.17±142.51)nmol/L、(109.62±18.87)μg/L和(4.82±2.98)mg/L,明显高于A组(P0.05);三组术后并发症发生率比较差异无统计学意义(P0.05)。结论腹腔镜经胆囊管胆道探查术治疗胆管结石有较好的效果,值得临床推广使用。     

急性结石性胆囊炎腹腔镜胆囊切除术对患者应激及免疫功能的影响

目的探讨急性结石性胆囊炎腹腔镜胆囊切除术对患者应激及免疫功能的影响。方法随机将70例急性结石性胆囊炎患者分为2组,各35例。对照组行传统开腹手术,观察组行腹腔镜手术,比较2组应激和免疫功能指标。结果对照组应激指标高于观察组,免疫功能指标低于观察组,差异有统计学意义(P 0. 05)。结论急性结石性胆囊炎腹腔镜胆囊切除术可有效缓解应激反应,维护免疫功能,提升治疗效果。     

腹腔镜胆囊切除和下腹部妇科腹腔镜术后肺功能的比较研究

目的:比较腹腔镜胆囊切除和下腹部妇科腹腔镜术后患者肺功能改变的不同。方法:30例女性患者分为3组:腹腔镜胆囊切除组(A组),下腹部妇科腹腔镜手术组(卵巢囊肿、宫外孕)(B组)和微创妇科腹腔镜手术组(诊断、输卵管结扎)(C组),每组10例。手术后第3、6小时和第1、2天各做1次肺功能检查。结果:A组患者术后肺功能明显改变,肺活量、第1秒用力呼气量和最大通气量均下降,B组术后当日肺功能有轻微改变,C组术后肺功能无改变。结论:下腹部妇科腹腔镜手术后肺功能的改变少于腹腔镜胆囊切除术,腹腔镜手术部位对术后肺功能变化有重要作用。     

经脐单孔腹腔镜胆囊切除术的学习曲线研究

目的:评估经脐单孔腹腔镜胆囊切除术不同阶段的手术情况和治疗效果,探讨其学习曲线。方法:回顾性分析我院2010年10月—2012年03月由同一组手术医师完成的80例经脐单孔腹腔镜胆囊切除术的临床资料,按手术时间先后次序分为A、B、C、D 4组,每组20例,比较各组在手术时间、术中出血量、中转率(增加Trocar或开腹)、并发症、术后住院时间、30 d再入院率等方面的差异,分析不同阶段手术效果。结果:4组患者在年龄、性别、体重指数(BMI)、疾病类型方面无明显差异(P>0.05)。A组平均手术时间(59.2±12.9 min)、术中出血量(19.6±8.0 mL)明显高于B组(46.5±11.2 min,13.5±7.3 mL)、C组(44.3±9.3 min,11.2±5.6 mL)、D组(42.5±8.6 min,10.7±4.4 mL),差异有统计学意义(P<0.05)。各组在中转率、并发症、术后住院时间、30 d再入院率方面无明显差异(P>0.05)。手术频数由A组的1.5台/月上升到D组的6台/月。结论:经脐单孔腹腔镜胆囊切除术治疗胆囊良性疾病安全、可行,随着手术经验的积累,手术时间明显缩短,术中出血量减少,学习曲线约为20例。     

腹腔镜下胆道探查与内镜Oddi括约肌切开取石的研究

目的:探讨腹腔镜胆道探查取石,T管引流术和腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石治疗胆总管结石合并胆囊结石的临床应用价值。方法:统计分析研究组(77例腹腔镜胆道探查取石即LCH- TD及43例腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石即LC- EST)与对照组(60例常规开腹胆总管探查即OCHTD)胆总管结石合并胆囊结石患者的临床资料。结果:研究组胆总管结石合并胆囊结石120例中111例行微创手术取得成功,占92. 5%,与对照开腹探查组相比,术后恢复较好,住院时间短,取得了较满意的效果(P<0 .05);研究组中运用LCH -TD的患者较LC EST的患者手术操作时间、术后腹痛、恶心及住院天数差异有显著性(P<0. 05)。两者在胆总管内径及结石大小方面差异亦有显著性(P<0. 05)。结论:LCH -TD与LC -EST两种术式微创,安全且临床疗效可靠,能代替大部分开腹胆总管探查术;腹腔镜胆总管探查取石法总体上优于腹腔镜胆囊切除一期联合内镜Oddi括约肌切开取石法。胆总管直径>1 0cm者行LCH- TD是一种安全可行的方法。若胆总管内径<1cm,且胆总管结石<1 0cm,建议行LC- EST。     

有上腹部手术史患者行腹腔镜胆囊切除术的临床分析

目的:探讨上腹部手术后患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性和应用价值。方法:回顾分析我院2003年1月至2007年12月为141例有上腹部手术史患者行LC的临床资料。结果:141例中135例顺利完成手术,平均手术时间43min。2例胃肠损伤于镜下完成修补,1例术后24h发现腹膜炎开腹探查;5例因腹腔粘连严重中转开腹,全部病例均治愈。结论:有上腹部手术史患者行LC安全可行。     

三种不同术式治疗胆囊结石合并胆总管结石的临床研究

目的:对比分析三种不同术式治疗胆囊结石合并胆总管结石的疗效.方法:将102例胆囊结石合并胆总管结石患者随机分为3组,A组行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+胆总管探查术(laparoscopic common bile duct exploration,LCBDE);B...     

腹腔镜胆囊切除术对机体免疫功能的影响

目的：比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法：随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组（laparoscopic cholecystectomy,LC组）和开腹胆囊切除组（open cholecystectomy,OC组）各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3^＋（T细胞总数）、CD4^＋（T辅助/诱导细胞）和CD8^＋的数量。结果：两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3^＋、CD4^＋、CD8^＋与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3^＋、CD4^＋、CD8^＋均明显低于LC组。结论：腹腔镜手术对机体的免疫功能影响小,术后恢复快。     

Single-Incision Versus Conventional Laparoscopic Cholecystectomy: a Case Control Study

Background : Single-incision laparoscopic surgery (SILS) is a minimally invasive technique which can be used for treatment of gallbladder disease. To evaluate our initial experience, patients treated with SILS cholecystectomy were compared with a comparable group of patients treated with a conventional four trocart technique (LC). Methods : Between May 2009 and April 2010, 60 SILS cholecystectomies were performed. These patients were matched by Body Mass Index (BMI) with 60 cases of conventional LC.

Results : The operative time was significantly longer in the SILS group 55 min (range, 25–126 min) compared to 49 min (range, 28–75 min) for the LC group. Excluding the first 15 SILS cases the operative time became comparable to the conventional technique, with a mean operative time of 51 min (range, 25–90 min). No patients were converted to open cholecystectomy. In the SILS group 3 patients developed a wound infection, in the conventional LC group 2. Conclusion : SILS cholecystectomy seems to be a safe and feasible procedure when performed by an experienced laparoscopic surgeon. Complication rates are comparable to conventional LC. With a learning curve of around 10 to 15 procedures, operative times approach those of conventional LC.     

Early minilaparoscopic cholecystectomy in patients with acute cholecystitis

BACKGROUND: Recently, techniques using fine-caliber instruments (2 or 3 mm in diameter) for laparoscopic cholecystectomy, called minilaparoscopic cholecystectomy (MLC), were reported to be superior to conventional LC (CLC, using 5 mm instruments) in postoperative course and cosmetic outcome. However, the use of MLC to date has been largely restricted to uncomplicated situations. Since CLC has been proved to be a safe and efficient technique for acute cholecystitis especially if conducted early, this study tests the feasibility and safety of MLC for acute cholecystitis. METHODS: Sixty-nine consecutive patients with acute cholecystitis were prospectively randomized to minilaparoscopic (n = 38) or conventional laparoscopic (n = 31) cholecystectomy, and the operations were conducted within 2 days of admission whenever possible. Despite different operative techniques, both groups of patients received identical preoperative preparation, evaluation and postoperative care. The two groups were compared for patient characteristics, results of laboratory tests, predictive score for LC difficulties, operative time, operative complications, hospitalization days and need for meperidine injection for wound pain. RESULTS: The conversion rate was 7.9% (3 of 38) for the MLC group and 6.5% (2 of 31) for the CLC group. Nine patients in the MLC group and 7 in the CLC group had concomitant choledocholithiasis and underwent endoscopic stone retrieval before operation. The age, sex, predictive score for LC difficulties, preoperative leukocyte count, length of hospital stay and requirement of intramuscular meperidine injections were similar for both groups of patients, while, the operative times were marginally longer in the MLC group (113.8 +/- 30.8 versus 98.2 +/- 33.2 minutes, P = 0.056). No major complications occurred in either group. CONCLUSIONS: The results of cholecystectomy for acute cholecystitis by MLC are as good as those of CLC if the operation is performed early, with obvious smaller incisions and minimal complications. MLC is a safe and effective procedure for patients with acute cholecystitis, and has an acceptable low conversion rate.     

A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis

BACKGROUND: Few articles address the issue of LC in patients with cirrhosis. Existing articles are retrospective and with small sample sizes, which makes it difficult to draw conclusions about indications and complications with LC in this setting. STUDY DESIGN: An extensive search of the Medline, Embase, and Cochrane databases using the terms "laparoscopic cholecystectomy" and "cirrhosis" or "cirrhotic" was conducted. The data from each study were extracted, combined with those of similar studies, and analyzed. RESULTS: Twenty-five publications (400 patients with cirrhosis undergoing LC) from 1993 to 2001 were identified. Four articles compared LC with open cholecystectomy in patients with cirrhosis, and six compared patients with cirrhosis to patients without cirrhosis. Patients were primarily in Child-Pugh class A or B, with only six patients in Child-Pugh class C. Compared with patients without cirrhosis, patients with cirrhosis had higher conversion rates (7.06% versus 3.64%, p = 0.024), operative times (98.2 minutes versus 70 minutes, p = 0.005), bleeding complications (26.4% versus 3.1%, p < 0.001), and overall morbidity (20.86% versus 7.99%, p < 0.001). Acute cholecystitis was evident in 47% of patients with cirrhosis versus 14.7% of patients without cirrhosis (p < 0.001). When LC was compared with open cholecystectomy in patients with cirrhosis, LC was associated with less operative blood loss (113 mL versus 425.2 mL, p = 0.015), operative time (123.3 minutes versus 150.2 minutes, p < 0.042), and length of hospital stay (6 days versus 12.2 days, p < 0.001). CONCLUSIONS: Patients with cirrhosis undergo cholecystectomies for more emergent reasons and have higher morbidity. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis. Prospective studies will establish which factors affect outcomes and determine the appropriateness of LC in Child's-Pugh class C cirrhosis.     

老年人急性胆囊炎的腹腔镜手术治疗

目的探讨老年人急性胆囊炎采用腹腔镜手术治疗的临床效果与应用价值。方法回顾性分析105例因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组(LC组)和剖腹胆囊切除术组(OC组)。结果两组患者手术时间、肠功能恢复时间及住院天数差异均有统计学意义(P<0.01),LC组优于OC组;术中出血、腹腔引流量和术后并发症两组差异无统计学意义(P>0.05)。结论老年急性胆囊炎患者行腹腔镜治疗是安全可行的。     

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...     

Clipless laparoscopic cholecystectomy by ultrasonic dissection

BACKGROUND: Ultrasonically activated devices have been used in gallbladder dissection in the laparoscopic cholecystectomy with encouraging results. The aim of this study was to compare between the safety and efficacy of the harmonic shears and the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the laparoscopic cholecystectomy. METHODS: In this prospective study, 120 patients with symptomatic gallstone disease were randomly assigned to either the harmonic scalpel laparoscopic cholecystectomy group (HS group=60 patients) where closure and division of the cystic duct was achieved solely by the harmonic shears or the clip and cautery laparoscopic cholecystectomy group (C&C group=60 patients). RESULTS: Neither minor nor major bile leaks were encountered in either group. Similarly, no bile-duct injuries were encountered in the present study. The incidence of gallbladder perforation was statistically significantly higher in the C&C group, compared to the HS group (30 vs. 10%, respectively; P=0.002). The median operative time was statistically significantly shorter in the HS group than in the C&C group (32 vs. 40 minutes, respectively; P=0.000). No statistically significant difference was found in the incidence of postoperative complications between both groups. CONCLUSIONS: The harmonic shears are as safe and effective as the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the laparoscopic cholecystectomy. Further, it provides a superior alternative to the currently used high-frequency monopolar technology in terms of shorter operative time and lower incidence of gallbladder perforation.