两种老年糖尿病胆囊切除术疗效观察

目的:观察比较两种老年糖尿病患者胆囊切除术式的优缺点.方法:将老年糖尿病需胆囊切除72例分为腹腔镜胆囊切除术(LC)组和开腹胆囊切除术(OC)组,各36例.比较两组手术时间、术中出血量、术后疼痛和发热、术后排气时间、术后并发症及住院时间.结果:LC组手术时间、术中出血量、术后疼痛和发热、术后排气时间、住院时间与OC组比较,差异显著(P＜0.05);两组术后并发症比较,差异不显著(P＞0.05).结论:LC是老年糖尿病患者胆囊切除的首选方法.     

高原地区腹腔镜胆囊切除术对胃肠功能的影响

目的探讨高原地区腹腔镜胆囊切除术(LC)对胃肠道功能恢复的影响因素。方法回顾性分析LC 216例和OC 163例,观察患者的肛门排气时间和腹腔气体吸收时间,并分为急诊手术组、择期手术组进行统计分析。结果在择期手术中,LC组患者恢复肛门排气时间短于OC组(P<0.01),而在急诊手术中,两组患者恢复肛门排气的时间差别无统计学意义(P>0.05);在择期手术中,术后第3天,LC组和OC组患者的腹腔膈下游离气体吸收率分别为72%和38%(P<0.01),而急诊手术中,两组的吸收率分别为29%和24%(P>0.05)。结论腹部切口的大小、胆囊急性炎症和CO2气腹是影响高原地区LC术后胃肠功能恢复的主要因素。     

腹腔镜胆囊切除术治疗急性胆囊炎临床分析

目的探讨腹腔镜胆囊切除术(LC)治疗急性胆囊炎的手术时机及效果。方法对实施腹腔镜胆囊切除术466例分急诊手术、限期手术组与择期手术组,对比分析三组手术时间、术后住院时间、中转开腹率及并发症发生率。结果急诊手术组80例,中转开腹5例(6.25%);限期手术组111例,中转开腹13例(11.7%);择期手术组275例,中转开腹8例(2.9%)。术后平均住院时间分别为7.1天、9.1天、6.5天。平均手术时间分别为55分钟、95分钟、50分钟。并发症率分别为1.25%、0.90%、0.36%。三组患者均痊愈出院。结论急性胆囊炎在发病早期是行LC的最好时期,择期手术仍切实可行;正确处理胆囊管及胆囊动脉是LC手术的关键;正确对待中转开腹是手术安全的保障。     

飞行人员腹腔镜胆囊切除术后缩短地面观察时间的探讨

我院从 1990年 8月至 2 0 0 1年 7月为军、地飞行人员胆囊良性疾病施行腹腔镜胆囊切除术 (laparoscopiccholecys tectomy ,LC) 4 2例 ,现就病人基本情况 ,手术前后相关指标变化 ,临床治愈后 3个月随访结果与此前 15年间 (1975年 6月至 1990年 7月 )同类疾病人群中施行的 4 5例开腹胆囊切除术 (openlaparo cholecystectomy ,OC)进行对比分析 ,旨在就LC术后缩短地面观察时间 ,提前作飞行合格结论进行探讨。一、一般资料LC组 4 2例 ,其中男 35例 ,女 7例 ,年龄 2 4至 4 9岁。OC组 4 5例 ,男 32例 ,女 13例 ,年龄 2 5至 4 7岁。两组病人的疾…     

腹腔镜与开腹胆囊切除治疗早期急性胆囊炎的疗效对比研究

目的:比较腹腔镜胆囊切除术与开腹胆囊切除术治疗急性胆囊炎的疗效。方法:将118例急性胆囊炎患者随机分为腹腔镜组和开腹组,观察两组患者术中情况、术后恢复情况及并发症发生情况。结果:行腹腔镜胆囊切除术患者的手术时间、术中出血量、术后引流量、术后肛门排气时间、术后下床时间、总住院时间均明显低于开腹胆囊切除术组(P<0.05);两组术后并发症发生率无明显差异(P>0.05)。结论:腹腔镜胆囊切除术是急性胆囊炎早期可行的手术方式。     

腹腔镜胆囊切除术与直视微创胆囊切除术的对比研究

目的对腹腔镜胆囊切除术与直视微创胆囊切除术进行对比研究，探讨胆囊切除术适应证患者的理想术式。方法 回顾200例腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）与200例直视微创胆囊切除术的（mini—incision cholecystectomy，MC）临床资料，从手术通应证、术前准备、麻醉选择、手术创伤、并发症等方面对比分析两者的优缺点。结果两者比较LC创伤小、恢复快、并发症较少而MC并发症较多，术后恢复较慢。结论两种方式均具有微创特点，但是LC仍为适应胆囊切除术患者的首选。     

高原条件下腹腔镜胆囊切除术气腹对呼吸系统功能的影响

目的探讨高原条件下腹腔镜胆囊切除术(LC)和开腹胆囊切除术(OC)对患者围术期呼吸系统参数的影响,比较两种术式的安全性。方法选择LC患者30例,OC患者30例,术中对比各时点(气腹后10、20、30min、放气后5min)呼吸系统参数(PETCO2、Paw、MVE、VCO2、VO2)的变化情况,手术前和手术后第1、4天复查,测定项目包括用力肺活量(FVC)、1s用力呼气容积(FEV1)、最大通气量(MVV)、肺活量(VC)以及深吸气量(IC),并进行对比。结果两组之间比较,所有指标差异均有统计学意义(P<0.05)。结论相对于OC,高原条件下LC对机体的肺功能影响小,是一种安全可靠的手术方式。     

内镜括约肌切开术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石的临床研究

目的探讨内镜括约肌切开术（EST）联合腹腔镜胆囊切除术（LC）治疗胆囊结石合并胆总管结石的临床效果。方法回顾性分析2009年2月～2010年12月行手术治疗的70例胆囊结石合并胆总管结石患者的临床资料,38例行EST＋LC（微创组）,32例行开腹胆囊切除＋胆总管切开取石＋T管引流术（OCHTD）（开腹组）,记录手术情况、术后恢复情况、手术疗效及住院时间。结果微创组手术时间、术中出血量、肛门通气时间及术后住院时间显著低于开腹组,相比较有显著性差异（P〈0.05）。两组均手术成功,微创组术后未发现残余结石,开腹组残余结石率为21.9%,两组相比较有显著性差异（P〈0.05）。微创组并发症发生率显著低于开腹组（P〈0.05）。结论 EST＋LC优于传统开腹手术,其疗效确切、安全可靠,可作为治疗胆囊结石合并胆总管结石的主要方法。     

肝硬化患者行腹腔镜胆囊切除术探讨

目的探讨腹腔镜胆囊切除术（LC）在肝硬化患者合并胆囊疾病中的可行性与疗效。方法回顾分析32例肝硬化合并胆囊疾病实施腹膛镜胆囊切除术的临床资料。结果32例中顺利施行腹腔镜胆囊切除术30例，2例因出血而中转开腹。术后出现腹水3例，胆漏1例，经引流、保肝等治疗后痊愈。无腹腔感染及肝功能衰竭等严重并发症。结论肝功能ChildA、B级的肝硬化患者合并胆囊疾病行LC手术是可行的。加强围手术期处理是保证手术成功的关键。     

腹腔镜胆囊切除术放置引流管的作用及护理

腹腔镜胆囊切除术(LC)已在我国许多大中城市医院开展。早期统计资料表明,在开展LC的初期,并发症的发生率高于开腹胆囊切除术(OC),主要并发症为漏胆、出血、内脏损伤等。LC术中置放的肝下间隙引流管为术后观察这些并发症提供了一个“窗口”,因此术后对腹腔引流物的观察和对引流管的护理就显得十分重要。     

Sonography for selecting candidates for laparoscopic cholecystectomy: a prospective study

OBJECTIVE: We assessed the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to conventional cholecystectomy. SUBJECTS AND METHODS: Upper abdominal sonography was performed (according to a checklist) in 75 consecutive patients before laparoscopic cholecystectomy. Sonographic findings were verified by the surgeon in the operating room. RESULTS: Conversion from laparoscopic surgery to laparotomy was performed in five patients (6.7%). Of 75 patients, 19 had sonograms revealing gallbladder wall thickening (>4 mm); surgical preparation difficulties in 16 of these patients led to laparotomy in four patients. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of technical difficulties were 66.7%, 94.1%, 84.2%, and 85.3%, respectively. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of surgical conversion were 80.0%, 78.6%, 21.1%, and 78.7%, respectively. Technical difficulties at laparoscopy occurred in all five patients with pericholecystic fluid on sonography (sensitivity, 20.8%; specificity, 100%; positive predictive value, 100%; accuracy, 74.7%) and led to laparotomy in three patients (sensitivity 60.0%, specificity 97.1%, positive predictive value 60%, accuracy 94.7%). The accuracy of sonography for cholecystolithiasis was 100%. CONCLUSION: On sonography, gallbladder wall thickening is the most sensitive indicator and pericholecystic fluid is the most specific indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.     

超声刀在腹腔镜胆囊切除术中的应用分析

目的探讨使用超声刀行腹腔镜胆囊切除术(LC)的手术技巧及体会。方法对500例胆囊良性疾病使用超声刀行LC病例进行回顾性分析,分别经脐部、剑突下及右上腹肋缘下戳孔行三孔法手术,必要时改行四孔法或中转开腹手术确保手术安全。结果 486例成功施行三孔法LC,9例中转四孔法LC,5例中转开腹胆囊切除手术;全组患者均痊愈出院,3例剑突下切口轻微感染,1例脂肪液化,经换药治疗均痊愈,无严重并发症发生。结论超声刀LC安全可行。     

腹腔镜与开腹胆囊切除术后胃肠动力恢复临床研究

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、频率及术后腹压、肠鸣音恢复时间、肛门排气时间等几项指标联合观察了15例腹腔镜胆囊切除患者及15例开腹胆囊切除患者。结果:腹腔镜胆囊切除术组患者手术后胃动素、胃泌素、腹腔压力、胃电图振幅及慢波比率恢复要快于开腹胆囊切除术组。腹腔镜胆囊切除术组术后肠鸣音恢复时间及肛门排气时间也明显短于开腹胆囊切除术组。结论:腹腔压力的尽快恢复有益于胃肠动力的恢复,腹腔镜胆囊切除术后患者胃肠动力恢复较开腹胆囊切除术后快。     

Routine cholecystectomy in the morbidly obese

Proven disease is generally considered a sound indication for cholecystectomy. However, incidental removal of a gallbladder with unproven pathology is controversial. The morbidly obese, however, constitute a group at especially high risk for the development of gallbladder disease, with possible greater risk immediately after weight reduction procedures. In our series of 51 consecutive patients undergoing vertical banded gastroplasty (VBG), the gallbladder was routinely removed regardless of symptomatology or results of a preoperative workup. Two patients declined cholecystectomy. Twelve patients (24.4%) had undergone cholecystectomy for symptomatic stones prior to their VBG. Of the remaining 37 subjects, there was a 73% overall incidence of disease: 11 (29.7%) had cholelithiasis, 11 (29.7%) had cholesterolosis alone, three (8.1%) had chronic cholecystitis with cholesterolosis, and two (5.4%) had chronic cholecystitis alone; only 10 (27%) had normal findings. These results, when added to evidence demonstrating a high incidence of postoperative gallbladder disease in those not receiving cholecystectomy, suggest that routine cholecystectomy be considered in all morbidly obese patients undergoing VBG or similar procedures.     

单孔法与三孔法腹腔镜胆囊切除术疗效比较

 目的 比较单孔法与三孔法腹腔镜胆囊切除术的疗效。方法 2013-01至2013-12我院按单孔法手术适应证收治胆囊良性疾病68例,按患者意愿分组后分别行经脐单孔多通道法(n=36)和三孔法(n=32例)腹腔镜胆囊切除术,比较两组手术时间、术中出血量、取胆囊时间、手术并发症发生情况、术后进食时间、术后疼痛评分、术后切口满意度,以及住院时间、住院费用等。结果 单孔法组有4例因胆囊三角解剖困难改行三孔法完成手术,其余患者均顺利完成手术,无并发症发生,无中转开腹手术。两组在术中出血量、手术并发症发生情况、术后进食时间等方面差异无统计学意义。在其他指标方面,单孔法和三孔法手术时间分别为(50.7±25.4)min和(25.4±8.5)min,疼痛评分分别为 (1.2±0.5)分和(2.7±0.6)分,术后切口满意度分别为(4.4±0.6)分和(3.1±0.8)分,住院费用分别为(6998.9±489.7)元和(8013.4±229.6)元,两组之间差异均有统计学意义(P＜0.01)。结论 常规器械行经脐单孔腹腔镜胆囊切除术是一种疼痛轻、美容效果确切、经济和安全可行的手术方法,但操作相对困难,需具备相当的技术条件及选择合适的病例进行。     

改良式小切口胆囊切除术150例分析

目的：探讨小切口胆囊切除术（MinilaparotomyCholecystectomy,MC）手术方法和技巧。方法：应用普通器械、小切口胆囊器械和腹腔镜电钩及深部打结推线器完成胆囊切除,并进行疗效分析。结果：共完成小切口胆囊切除150例。结论：小切口胆囊切除所用操作器械及方法各异,所用方法操作简便、出血少、安全高效,减轻手术创伤,减少异物残留,利于术后康复。     

超声引导下胆囊置管术在急性胆囊炎治疗中的临床应用

目的 探讨超声引导下胆囊置管术在急性胆囊炎治疗中的临床应用.方法 选取2016年10月-2020年9月普外科急性胆囊炎就诊患者54例,分为两组,观察组为超声引导下胆囊置管引流+腹腔镜下胆囊切除病例22例,对照组为腹腔镜下胆囊切除病例32例.结果 随访两组患者腹腔镜手术术中及术后情况,对比术中出血量、术后白细胞计数、并发...     

Preoperative evaluation of the feasibility of laparoscopic cholecystectomy

AIM: To determine the possibility of preoperative evaluation of the feasibility of laparoscopic cholecystectomy based on the standard preoperative examinations and findings. METHODS: During 1997, 100 consecutively operated patients with the diagnosis of chronic calculous cholecystitis were followed up. Sex and age, and the results of blood count, sedimentation rate, ultrasonography (US), and intravenous cholangiography (IVC) were monitored. Based on adhesions, fibrosis in Calot's triangle and pericholecystitis, surgical interventions were classified as minor and major. RESULTS: Minor operations were performed in 57, and major in 43 patients. Earlier surgical interventions had been carried out in 8 (18.6%) patients from the major surgery group, while 9 (15.79%) patients had undergone minor surgery. Out of 57 patients with minor surgery, IVC verified the contrast medium filling of the gallbladder in 55 (96.49%) of the patients. Tense gallbladder or wall stratification was not revealed by ultrasonography in any of the patients from this group. Out of 43 patients with major surgery, the gallbladder was not filled with the contrast medium during IVC in 34 (79.07%) patients, while the stratified and tense gallbladder was found by US in 2 (4.65%) patients. The mean sedimentation rate was 14.3 in the patients with minor surgery, and 23.5 in major surgery group. Mean WBC in the patients with minor surgery was 7.4 x 10(9). The patients with major surgery had slightly increased mean value of the white cell count. It was 8.3 x 10(9). CONCLUSION: Statistically significant difference (p < or = 0.05) was found between the variables of the IVC, sedimentation rate, the white blood count, and the earlier operations. No significant difference was found between other analyzed variables.