腹腔镜胆囊切除术失败的相关因素研究

目的探讨腹腔镜胆囊切除术失败中转开腹的相关危险因素。方法对50例腹腔镜胆囊切除术失败的患者和同期300例腹腔镜胆囊切除术成功施行患者的临床资料进行对比研究,运用多因素方差分析和Logistic分析探讨导致中转开腹的相关危险因素。结果胆囊炎急性发作、胆囊壁较厚、胆总管直径增宽、总胆红素升高、胆囊结石嵌顿是腹腔镜胆囊切除术失败的危险因素。结论腹腔镜胆囊切除术术前对上述危险因素进行综合评估有利于选择正确手术方式,减少严重并发症的发生。     

腹腔镜胆囊切除术治疗急性胆囊炎

目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎及慢性胆囊炎急性发作的方法及疗效。方法:回顾分析2003年3月- 2006年5月行腹腔镜胆囊切除治疗急性胆囊炎及慢性胆囊炎急性发作患者128例的临床资料。结果:腹腔镜胆囊切除术128例中124例成功,平均手术时间85 min,1例术后出血;4例中转开腹手术,中转开腹率2.34%;并发症发生率0.81%。结论:急性胆囊炎或慢性胆囊炎急性发作病例行腹腔镜胆囊切除术可行、有效,必要时可适当放宽手术指证。解剖胆囊三角显露胆囊管是手术的关键。当腹腔镜手术遇困难时,可适时中转开腹手术。     

急性胆囊炎患者腹腔镜胆囊切除术转开腹手术的危险因素分析

选取2013年5月~2014年6月于我院行腹腔镜胆囊切除术的85例急性胆囊炎患者,将50例中转开腹者纳入观察组,其余3 5例纳入对照组,比较两组性别、年龄、有无胆囊管结石嵌顿、有无坏疽性胆囊炎、术前白细胞计数、总胆红素水平等资料,同时采用logistic多因素回归分析法分析患者腹腔镜胆囊切除术中转开腹手术的独立危险因素。观察组在年龄、有胆囊管结石嵌顿、有坏疽性胆囊炎、术前白细胞计数、总胆红素水平等方面与对照组比较有统计学意义(P0.05);多因素logistic回归分析结果显示年龄≥60岁、胆囊三角解剖不清、有坏疽性胆囊炎是引起急性胆囊炎患者腹腔镜胆囊切除术中转开腹的独立危险因素(P0.05)。急性胆囊炎患者在腹腔镜胆囊切除术中易受年龄、胆囊三角解剖不清、有坏疽性胆囊炎等因素而需中转开腹,临床术前评估时应综合考虑以选择合适的手术方式。     

腹腔镜胆囊切除术中转开腹原因26例分析

目的 了解腹腔镜胆囊切除术中转开腹的原因.方法 对2 500例腹腔镜胆囊切除术其中26例中转开腹的病例分析.结果 2500例腹腔镜胆囊切除术中中转开腹26例,中转手术率1.04％,中转开腹的主要原因为:慢性萎缩性胆囊炎12例(46.2％);急性化脓坏疽性胆囊炎8例(30.8％);胆囊动脉出血2例(7.7％);与横结肠致密粘连1例(3.8％);胆管损伤3例(11.5％).结论 腹腔镜胆囊切除术中转开腹的主要原因为:腹腔内的严重粘连、急性炎症水肿、坏疽、血管损伤、胆管损伤.提高腹腔镜技术,严格掌握手术适应证,可降低中转开腹率,及时中转开腹可减少并发症的发生.     

影响腹腔镜胆囊手术转开腹手术危险因素分析

目的分析腹腔镜胆囊切除转开腹手术的相关危险因子。方法对1998年1月至2007年12月在上海新华医院普外科进行腹腔镜胆囊手术的2550例患者的临床病例资料进行回顾性分析。结果2550例患者中,255例转为开腹术（10．00％）。其中,高龄、男性、体重超重、有急性胆囊炎史、有上腹部手术史、糖化血红蛋白高,以及低年资医师主刀等是中转开腹的危险因素。慢性肝病不是危险因素。结论丰富的手术经验是避免中转开腹的重要因素。此外,术前仔细分析患者病史及检查结果并以此规划手术细节,有助于降低中转开腹的几率。     

腹腔镜胆囊切除术转开腹的相关因素1:3配对病例对照研究

目的探讨腹腔镜胆囊切除术转开腹的相关危险因素。方法采用病例对照组研究对70例腹腔镜胆囊切除术转开腹和210例腹腔镜胆囊切除术成功的患者的临床资料进行对比研究。结果单因素分析显示年龄≥60岁,急性胆囊炎,胆囊壁较厚,胆总管直径增宽,总胆红素升高,开腹组比率明显高于对照组,差异有显著的统计学意义(P<0.01),男性比率开腹组高于成功组,差异有统计学意义(P<0.05)。多因素非条件Logistic回归分析显示:年龄≥60岁、男性、急性胆囊炎、胆囊壁较厚(≥4 mm)、胆总管直径增宽(≥8 mm)、总胆红素升高(>17.1 mol/L)是腹腔镜胆囊切除术转开腹的危险因素。结论有转开腹危险因素的患者应尽量避免进行腹腔镜胆囊切除术或者由腹腔镜手术丰富的临床医师进行腹腔镜胆囊切除术。     

腹腔镜胆囊切除即刻中转开腹手术临床分析(附236例报告)

目的：总结腹腔镜胆囊切除术（LC）即刻中转开腹手术的临床经验。方法：回顾分析11436例LC即刻中转开腹的临床资料。结果：LC即刻中转开腹手术的发生率为2.06%，主要原因是急性胆囊炎，近期有急性胆囊炎发作史，胆囊周围粘连，胆囊颈部结石嵌顿，Calot三角解剖不清，难以辨认胆囊管，胆总管损伤。结论：正确掌握中转开腹的时机是降低LC手术并发症的有效措施。提高腹腔镜基本技术，控制手术适应症和必要的辅助检查有利于降低LC中转手术率。     

急性结石性胆囊炎LC手术时机及中转开腹影响因素的探讨

【目的】探讨急性结石性胆囊炎腹腔镜手术预后与手术时机的关系,并对中转开腹的影响因素进行分析。【方法】回顾性分析本院2007年至2011年收治的急性结石性胆囊炎腹腔镜手术患者119例的临床资料,依据出现症状到手术时间长短分为三组：48h以内的49例（A组）,48～72h的41例（B组）,大于72h的29例（C组）,比较三组患者手术时问、中转开腹率、并发症和住院时间,并分析影响三组患者中转开腹的因素。【结果】A组手术时间最短,与B组、C组比较均有统计学差异（P〈0．05）,C组在中转开腹率、并发症和出院时问方面显著高于A组和B组（P〈0．05）,但A组和B组比较无统计学差异（P〉0．05）;Logistic回归结果显示白细胞计数、胆囊颈部结石嵌顿和手术时机是中转开腹的影响因素,且随着0R值增大,危险性越高。【结论】急性结石性胆囊炎症状发作后48h内是腹腔镜手术的最佳时机,白细胞计数、胆囊颈部结石嵌顿和手术时机是中转开腹的危险因素,只要掌握正确时机,适时中转手术,急性结石性胆囊炎腹腔镜胆囊切除术是安全可行的。     

腹腔镜胆囊切除术治疗急性胆囊炎

目的：探讨腹腔镜胆囊切除术治疗急性胆囊炎的方法和经验。方法：回顾分析2008年10月—2010年9月行腹腔镜胆囊手术的54例急性胆囊炎患者的临床资料。结果：在54例急性胆囊炎患者中45例72h内手术,9例72h后手术,其中最长者发病5d手术;成功完成腹腔镜手术53例,中转开腹1例。结论：急性胆囊炎、胆囊结石患者应在72h内行腹腔镜胆囊切除术,病程长、操作困难、高龄和合并有心血管疾病的患者应及时中转开腹手术。     

腹腔镜胆囊切除术治疗急性胆囊炎82例分析

目的：探讨腹腔镜胆囊切除术治疗急性胆囊炎的方法及疗效。方法：回顾性分析我院2005-10/2008-10急性胆囊炎行腹腔镜胆囊切除术82例的临床资料。结果：78例成功完成腹腔镜胆囊切除术,4例中转开腹手术,26例温氏孔放置引流管。结论：急性胆囊炎行腹腔镜胆囊切除术可行、有效。严格掌握手术指征、规范操作、合理放置引流是手术关键。腹腔镜手术遇困难时,可适时中转开腹。     

急性结石性胆囊炎腹腔镜胆囊切除中转开腹影响因素分析

目的:探讨急性结石性胆囊炎行腹腔镜胆囊切除术过程中转开腹的影响因素。方法:回顾性分析3191例急性结石性胆囊炎行腹腔镜胆囊切除术患者的临床资料,按术中是否中转开腹胆囊切除术分为中转组和非中转组,通过多元回归模式对患者性别、年龄、BMI、既往病史(糖尿病病史、高血压病史及既往腹部外科手术史)、术前实验室检查(WBC、PCT、CRP及INR)、术前胆囊B超特征(胆囊结石数量、胆囊壁厚度)及手术时间等因素进行统计学分析。结果:资料数据经多元logistic回归分析显示,BMI、糖尿病病史、术前白细胞计数、PCT、CRP、结石数量、胆囊壁厚度是影响急性结石性胆囊炎患者行腹腔镜胆囊切除中转开腹的因素(P<0.05);BMI(OR=1.784;95%CI:1.621~1.973;P<0.001)、糖尿病病史(OR=21.79;95%CI:13.49~34.90;P<0.001)、WBC(OR=1.330;95%CI:1.254~1.410;P<0.001)、PCT(OR=1.839;95%CI:1.631~2.079;P=0.004)、CRP(OR=2.025;95%CI:1.019~4.031;P=0.004)升高及胆囊壁增厚(OR=1.680;95%CI:1.520~1.859;P<0.001)为中转开腹的独立危险因素,而结石数量(OR=0.422;95%CI:0.273~0.643;P=0.0005)为中转开腹的保护因素。结论:急性结石性胆囊炎患者实施腹腔镜胆囊切除术时,对BMI超标、术前有糖尿病病史、术前WBC、PCT及CRP较高或B超显示胆囊壁增厚、结石单发的患者,应考虑术中中转开腹手术可能。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎

目的总结腹腔镜胆囊切除术治疗急性结石性胆囊炎的临床经验与价值。方法应用腹腔镜手术设备与器械为86例急性结石性胆囊炎病例实施了手术治疗。结果腹腔镜胆囊切除术71例，腹腔镜胆囊大部切除术10例，术中中转开腹手术5例，均无胆漏、胃肠道损伤、胆管损伤等严重手术并发症。结论腹腔镜胆囊切除术治疗急性结石性胆囊炎是安全可行的，适时中转开腹手术，是避免发生胆管等组织器官损伤、降低手术并发症的关键措施。     

Effect of cholecystectomy on common bile duct diameters: a longitudinal prospective ultrasonographic study

The medium-term effect of cholecystectomy on common bile duct diameters (CBD) was investigated prospectively in 64 patients with gallstone disease examined by ultrasonography immediately before and 27 months to 39 months after the operation. In 32 patients with chronic cholecystitis and patent cystic ducts, CBD diameters increased slightly (median 4.6 mm pre- and 5.3 mm postoperatively; p less than 0.05). A group of 19 patients with acute cholecystitis or cystic duct occlusion showed a significant decrease (median 7.7 mm pre- and 5.5 mm postoperatively; p less than 0.05). In 13 patients with common bile duct stones, the CBD diameters also decreased significantly after surgical intervention (median 7.5 mm pre- and 5.0 mm postoperatively; p less than 0.05). The widest CBD diameter after cholecystectomy observed in this study was 10 mm. We conclude that either increases or decreases of the CBD diameters may occur after cholecystectomy in patients with calculous gallbladder disease, and that the postoperative evolution is governed by the exact nature of the underlying biliary disease at the time of the index operation.     

术前超声检查预测急性胆囊炎腹腔镜胆囊切除术的技术难度

目的评价术前超声检查预测急性胆囊炎腹腔镜手术技术难度.方法对73例因急性胆囊炎行腹腔镜胆囊切除术的患者行超声检查,超声检测参数:胆囊容积、胆囊壁厚度、胆囊壁增厚类型、结石大小、结石移动性、胆囊与胆囊床的粘连、肝与胆囊间的脂肪厚度、胆囊窝液体、总胆管扩张、总胆管结石、胆囊壁彩色和脉冲多普勒征像、邻近肝脏内的彩色和脉冲多普勒信号.腹腔镜胆囊切除手术分5步,每步根据难易程度记分:困难记1分,容易记0分,总分相加为总的难度分数.评价术前超声表现与总的难度分数、每一步难度分数、手术时间长短是否有显著关系.结果胆囊容积≥50 cm3、胆囊壁厚度≥3 mm、胆囊壁内丰富彩色血流信号与手术总难度分数显著相关;胆囊容积增大使粘连胆囊及Calot'三角分离困难;胆囊壁增厚及胆囊粘连者胆囊取出腹腔时较难;胆囊壁彩色血流丰富、邻近肝脏血流增加与手术时间延长有显著关系.结论术前测定胆囊容积、胆囊壁厚度、胆囊壁彩色血流丰富程度有助于预测急性胆囊炎腹腔镜胆囊切除手术中的技术难度.     

经腹腔镜胆囊切除术选择性术中胆道造影的临床应用价值

目的探讨术中胆道造影在腹腔镜胆囊切除术（LC）中的临床应用价值。方法分析2006年9月至2010年12月北京丰台长辛店医院及东城区第一人民医院180例慢性结石性胆囊炎、急性结石性胆囊炎、胆源性胰腺炎患者行LC患者的临床资料,统计分析其中20患者在术中经胆囊管插管行胆管造影（IOC）的临床数据。结果 20例LC术中胆管造影18例成功,成功率90.0%,术中发现胆总管结石2例,经中转开腹行胆总管切开取石,胆管变异1例;平均造影时间15±10.50 min。结论 LC中胆管造影操作较为简单方便、显影清晰、成功率高,既能发现术前未能发现的胆总管结石,又能发现胆管解剖变异;并能够有效地降低胆管残石率,及时发现术中胆管损伤,提高了LC的手术质量和安全性。     

急性胆囊炎腹腔镜胆囊切除术中转开腹的时机探讨

目的：探讨急性胆囊炎腹腔镜胆囊切除术中转开腹的时机。方法：分析112例急性胆囊炎腹腔镜胆囊切除中转开腹的原因。结果：中转开腹率为16．96％,主动中转开腹11例,被动中转开腹8例,胆囊三角解剖不清是中转开腹的主要原因。结论：急性胆囊炎腹腔镜胆囊切除术有困难的病例应及时果断中转开腹。     

86例急性结石性胆囊炎行腹腔镜胆囊切除术的体会

目的探讨腹腔镜治疗急性结石性胆囊炎的操作方法。方法对本院近几年施行的86例手术资料进行回顾性分析。结果成功完成LC78例（90．69％）,其中中转开腹8例（9．31％）。手术时间60～135min,平均90min。1例术后第2天发现胆漏,经再次手术证实系胆囊管上钛夹处破裂所致,无胆管损伤,所有病例均痊愈出院。结论随着腹腔镜手术经验的积累及技术的提高,急性结石性胆囊炎行LC、是安全可行的。     

Closure of the cystic duct orifice in laparoscopic subtotal cholecystectomy for severe cholecystitis

Introduction

Laparoscopic subtotal cholecystectomy (LSC) has been recognized as an alternative to conversion to laparotomy for severe cholecystitis. However, it may be associated with an increased risk of recurrent stones in the gallbladder remnant. The objective of this study was to evaluate the safety and feasibility of the complete removal of the gallbladder cavity in LSC for severe cholecystitis using the cystic duct orifice suturing (CDOS) technique.

Methods

In a consecutive series of 412 laparoscopic cholecystectomies that were performed from January 2015 to June 2017, 12 patients who underwent LSC with CDOS were enrolled in this retrospective study. In this procedure, Hartmann's pouch was carefully identified, and the infundibulum–cystic duct junction was transected while the posterior wall adherent to Calot's triangle was left behind. The clinical records, including the operative records and outcomes, were analyzed.

Results

The median operating time and blood loss were 158 min and 20 mL, respectively. In all cases, LSC with CDOS was completed without conversion to open surgery. No injuries to the bile duct or vessels were experienced. The median postoperative hospital stay was 6 days. Postoperative complications occurred in two patients (bile leakage, n = 1: common bile duct stones, n = 1) and were successfully treated by endoscopic management. A gallbladder remnant was not delineated by postoperative imaging in any of the cases.

Conclusion

These results suggest that LSC with CDOS is a promising approach that can avoid dissection of Calot's triangle and achieve the complete removal of the gallbladder cavity in patients with severe cholecystitis.

     

Single‐incision laparoscopic cholecystectomy for porcelain gallbladder: A case report

Single‐incision laparoscopic cholecystectomy (SILC) has been performed in patients with gallbladder stones without inflammation. Porcelain gallbladder is a rare finding of chronic cholecystitis that is characterized by extensive calcification of the gallbladder wall. Herein we describe our experience with SILC for porcelain gallbladder with a successful outcome. A 67‐old‐year woman was diagnosed with porcelain gallbladder. We performed SILC using a SILS Port and a 5‐mm forceps through the umbilical incision. Because a small amount of the omentum around the gallbladder was left to facilitate grasping the fundus, a view of both the cystic artery and the cystic duct was easily obtained. The operative time and the intraoperative blood loss were 66 min and less than 1 mL, respectively. The patient was discharged 3 days after surgery and was satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy in patients with porcelain gallbladder.