糖尿病患者胆囊切除术治疗效果的临床观察

目的观察分析糖尿病与非糖尿病患者治疗效果和糖尿病患者不同术式治疗效果。方法 2009年1月—2014年6月经笔者治疗的80例糖尿病（含应激性高血糖）患者行胆囊切除术,并选取同期具有可比性的80例非糖尿病行胆囊切除术患者为对照组,采用开腹和腹腔镜两种方式。结果糖尿病组术后水电解质紊乱、感染性并发症等发生率高于对照组（P〈0.05）,糖尿病患者开腹手术的切口感染率和平均住院时间均高于腹腔镜手术（P〈0.05）。结论糖尿病病人行胆囊切除术时,必须严格控制围术期血糖,手术方式力求简单,若无禁忌症,首选腹腔镜胆囊切除术。     

开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎对比观察

目的比较开腹及腹腔镜手术切除胆囊治疗结石性胆囊炎的疗效及并发症。方法 686例结石性胆囊炎患者中255例行传统开腹手术（开腹组）、431例行腹腔镜手术（腹腔镜组）切除胆囊,观察两组手术时间以及术后恢复情况和并发症发生情况。结果腹腔镜组的手术、住院、术后疼痛时间短于开腹组（P均〈0.05）,肛门排气、术后下床活动时间明显早于开腹组（P均〈0.05）,术后胆心反射和感染的发生率明显低于开腹组（P均〈0.01）。结论与开腹手术相比,腹腔镜手术切除胆囊治疗结石性胆囊炎创伤小、疼痛轻、康复快、并发症少。     

胆结石患者应用开腹手术和腹腔镜手术肠粘连机率的比较

目的比较胆结石患者应用开腹手术与腹腔镜手术发生肠粘连的机率,并探讨两种手术方法对患者生活质量的影响。方法选取我院治疗的120例胆结石患者为研究对象,根据采取手术治疗方法的不同分为观察组与对照组。观察组90例行腹腔镜手术治疗,对照组30例行开腹手术治疗,比较两组手术时间、术后疼痛、肛门排气时间、住院时间,观察两组术后肠粘连发生情况;对患者进行为期1年的随访,评价两组患者生活质量。结果观察组手术时间、肛门排气时间与住院时间均短于对照组(P0.05);观察组术后VAS疼痛评分为(7.84±0.2)分,低于对照组的(9.16±0.6)分(P0.05);观察组术后肠粘连发生率为11.11%,低于对照组的26.67%(P0.05);观察组术后6、12个月GLQI评分分别为(122.8±12.5)分、(124.6±12.4)分,高于对照组的(115.8±10.4)分、(118.7±10.1)分(P0.05)。结论与传统开腹手术比较,采用腹腔镜治疗胆结石可降低术后肠粘连发生率,改善患者生活质量,值得基层医院推广并应用。     

快速康复外科理念在老年患者围术期腹腔镜胆囊切除手术中的应用

目的探讨快速康复外科理念在腹腔镜胆囊切除术中的临床效果。方法选择2012年1月至2013年12月在该院行腹腔镜胆囊切除术的患者154例,随机分为对照组和观察组各77例。对照组围术期接受常规处理方案,观察组围术期接受快速康复外科(FTS)处理方案,比较两组患者的手术情况、术后恢复及并发症情况。结果两组患者的手术切口长度、术中出血量和手术时间差异均无统计学意义(P0.05);观察组术后排气时间、下床活动时间、排便时间、伤口愈合时间以及住院时间均较观察组显著缩短(P0.01);观察组术后并发症总发生率显著低于对照组(P0.01),其中观察组恶心呕吐和切口疼痛的发生率均较对照组显著降低(P0.05或P0.01)。结论在腹腔镜胆囊切除术应用FTS理念可改善患者术后恢复,并且可减少并发症的发生,值得临床推广。     

三孔法在急诊胆囊腹腔镜手术中的应用及临床疗效

目的评价急诊胆囊腹腔镜手术中应用三孔法的效果。方法选取2012年6月至2016年6月接诊的急诊胆囊手术患者200例作为研究对象,根据手术方式不同分为研究组(160例)和对照组(40例),对照组采用传统开腹胆囊手术治疗,研究组采用腹腔镜三孔法手术治疗。对两组患者手术时间、术中出血量、手术切口长度、住院时间、并发症发生率,以及术后患者对切口美观满意率进行观察分析。结果研究组患者手术时间、术中出血量、手术切口及住院时间明显小于对照组,患者对切口美观满意率明显高于对照组,两组比较差异均有统计学意义(P0.05)。结论急诊胆囊腹腔镜手术中实施三孔法处理,相比传统开腹手术治疗,不仅能缩短手术时间、减少术中出血量、降低手术创伤,而且能缩短住院时间、减少并发症发生、提高切口美观程度,安全性更好,值得推广应用。     

悬吊式免气腹腹腔镜辅助手术在胆囊切除术中的应用

目的 探讨悬吊式免气腹腹腔镜与气腹腹腔镜在胆囊切除术中的临床应用效果.方法 回顾性分析2007年3月1日至2008年6月1日在我科住院行腹腔镜胆囊切除术患者57例的临床资料,其中悬吊式免气腹腹腔镜手术23例,气腹腹腔镜手术34例,分别记录患者年龄、合并症、手术时间、术中出血量、中转开腹、术后并发症等指标.结果 两组患者均手术成功,术中出血量、手术时间、中转开腹、术后并发症无显著性差异(P＞0.05).结论 悬吊式免气腹腹腔镜辅助下胆囊切除术是一种安全、有效的手术方式,与气腹腹腔镜相比,避免了气腹对人体血流动力学的影响,扩大了腹腔镜胆囊手术的指征,是合并心肺功能不全等疾病的老年患者较理想的术式选择.     

老年高血压患者腹腔镜下胆囊切除术围手术期的护理

目的分析老年高血压患者行腹腔镜下胆囊切除术的围手术期护理方法及其实施效果。方法入选是80例研究对象均为2018年5月-2019年2月期间在我院行腹腔镜胆囊切除术的老年高血压患者,以其围手术期护理模式分为观察组和对照组,每组组内例数均40例。两组患者均行腹腔镜胆囊切除术治疗,期间对照组配合常规围手术期护理,观察组则给予综合性围手术期护理。结果患者术后首次下床时间、排气时间、首次进食时间、排便时间和术后住院时间,观察组均显著比对照组更短,P0.05,比较差异具有显著性。患者的舒张压水平、收缩压水平控制效果,观察组术前和术后均保持在较低水平,与对照组相比,均显著较低,P0.05,比较差异具有显著性。患者的中转开腹手术率和并发症发生率,观察组均比对照组明显更低,P0.05,比较差异具有显著性。结论对老年高血压行腹腔镜下胆囊切除术的患者实施综合性围手术期护理,能够促使患者围手术期血压水平保持相对稳定而合理的范围内,从而有利于降低手术风险,减少并发症,促进患者术后快速恢复。     

老年结石性胆囊炎腹腔镜与开腹胆囊切除的对比及胆囊炎病程对腹腔镜胆囊切除的影响

目的探讨老年结石胆囊炎腹腔镜与开腹胆囊切除的差异性以及胆囊炎病程对腹腔镜胆囊切除的影响。方法选取2008年1月至2013年1月该院收治的180例老年结石性胆囊炎患者,随机分成对照组和观察组,每组90例,对照组采用开腹胆囊切除术治疗,观察组采用腹腔镜胆囊切除术治疗,比较两组患者的手术时间、术中出血量、术后住院时间、下床活动时间、术后并发症以及感染发生情况。结果两组患者的手术时间比较差异无统计学意义(P>0.05);观察组术中出血量、术后住院时间以及下床活动时间均明显低于对照组,且与病程呈正相关(P<0.05);观察组术后并发症发生率和感染发生率均明显低于对照组(P<0.05),但与病程不相关(P>0.05)。结论腹腔镜胆囊切除术能明显减少老年结石性胆囊炎患者的术中出血量、术后住院天数和下床活动所需时间,明显降低患者的术后并发症和感染的发生率。较长的胆囊炎病程能够增加腹腔镜胆囊炎手术的难度,影响患者术后机体恢复,值得在临床治疗过程中关注。     

腹腔镜胆囊切除术在胆囊结石合并糖尿病的治疗体会

目的探讨胆囊结石合并糖尿病(DM)患者应用腹腔镜胆囊切除术治疗的效果。方法将该院2017年1月—2018年5月收治的72例胆囊结石伴DM患者随机分成观察组(36例)与对照组(36例),两组均给予患者降血糖治疗,在此基础上给予对照组患者行开腹手术,给予观察组患者行腹腔镜胆囊切除术,观察两组治疗效果。结果观察组术中出血量、术后引流时间及住院时间等指标均优于对照组,同时围术期间观察组患者血糖变化幅度也比对照组小,差异有统计学意义(P0.05);术后观察组并发症总发生率为5.56%,明显低于对照组22.22%的发生率(P0.05)。结论应用腹腔镜胆囊切除术治疗胆囊结石伴DM的疗效显著,且手术对患者血糖影响小,术后并发症低,值得推广。     

腹腔镜胆囊切除术及开腹胆囊切除术在胆结石合并胃溃疡患者中的疗效对比观察及对预后的影响

目的 探讨腹腔镜胆囊切除术和开腹手术在胆结石合并胃溃疡患者中的疗效对比观察及对预后的影响.方法 取2013-08/2016-09浙江新安国际医院收治胆结石合并胃溃疡患者120例,电脑抽取随机数字法分为开腹组(n=60)和腹腔镜组(n=60).开腹组采用传统开腹手术治疗,腹腔镜组采用腹腔镜胆囊切除术治疗,比较2组临床疗效及对预后的影响.结果 腹腔镜组术中出血量,少于开腹组(P0.05);腹腔镜组手术时间,长于开腹组(P0.05);腹腔镜组肛门排气时间、术后住院时间,短于开腹组(P0.05);腹腔镜组术后并发症发生率为6.67%,开腹组为11.67%,2组并发症发生率比较差异有统计学意义(P0.05).结论 胆结石合并胃溃疡患者采用腹腔镜胆囊切除术具有创伤小、恢复快等优点,能改善预后,值得推广应用.     

Laparoscopic cholecystectomy

Seventeen consecutive patients undergoing elective laparoscopic cholecystectomy (LC) were serially evaluated with transabdominal ultrasound before, one day after, and six days after LC to document what, if any, changes occur in the surgical bed and surrounding parenchyma. The most common postoperative finding was focal sonolucency in the hepatic parenchyma adjacent to the gallbladder fossa in six (35%) of 17 patients. Five patients (29%) had postoperative fluid collections in the gallbladder fossa; in four of these five, it was technically difficult to dissect the gallbladder from the liver at the time of original surgery. In one patient the fluid resolved by the sixth postoperative day. It persisted in the remaining four. Two patients had transient ductal dilation and one had pneumobilia. Shadowing and ring-down artifact was identified in 12 patients due to surgical clips in the triangle of Calot. Because gallbladder fossa fluid may persist up to six days after uncomplicated laparoscopic cholecystectomy, caution should be used before attaching significance to isolated imaging findings. Clinical judgement remains the best means of selecting which patients need additional evaluation.     

急性胆囊炎腹腔镜与开腹手术的对比分析

目的对比分析急性胆囊炎腹腔镜与开腹手术的临床疗效。方法回顾性分析2001年至2008年急性胆囊炎或慢性胆囊炎急性发作行胆囊切除术病例200例,其中行腹腔镜胆囊切除术（LC）67例,开腹胆囊切除术（OC）133例。结果LC组的术中出血量、手术时间、下床活动时间、肠道功能恢复时间、住院时间明显低于OC组（P〈0.05）;两组术后并发症发生率无明显差异（P〉0.05）。结论LC治疗急性胆囊炎的临床效果优于OC。     

A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy

OBJECTIVES: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC). Previous studies comparing outcomes in LC and OC used small selected cohorts of patients and did not control for comorbid conditions that might affect outcome. The aims of this study were to characterize the morbidity, mortality, and costs of LC and OC in a large unselected cohort of patients. METHODS: We used the population-based North Carolina Discharge Abstract Database (NCHDAD) for January 1, 1991, to September 30, 1994 (n = 850,000) to identify patients undergoing OC and LC. We identified the indications for surgery, complications, and type of perioperative biliary imaging used. We compared length of stay, hospital charges, complications, morbidity, and mortality between OC and LC patients. To account for variations in outcomes from differences in age and comorbidity between the OC and LC groups, we used the age-adjusted Charlson Comorbidity Index in regression analyses quantifying the association between type of surgery and outcome. RESULTS: Our cohort consisted of 43,433 patients (19,662 LC and 23,771 OC). The mean age-adjusted Charlson Comorbidity Index score was slightly higher for the OC compared to the LC group (4.3 vs 4.1, p < 0.05). The OC patients had longer hospitalizations, generated more charges ($12,125 vs $9,139, p < 0.05), and required home care more often. The crude risk ratio comparing risk of death in OC to LC was 5.0 (95% CI = 3.9-6.5). After controlling for age, comorbidity, and sex, the odds of dying in the OC group was still 3.3 times (95% CI = 1.4-7.3) greater than in the LC group. In the LC group, the number of patients with acute cholecystitis rose over the study period, whereas the number of patients with chronic cholecystitis declined. In the OC group, the number of patients with acute and chronic cholecystitis declined. The use of intraoperative cholangiography was greater in the OC group but declined in both groups over the study period. The use of ERCP was greater in the LC group and increased in both groups over time. CONCLUSIONS: The introduction of LC has resulted in a change in the management of cholecystitis. Despite a higher proportion of patients with acute cholecystitis, the risk of dying was significantly less in LC than in OC patients, even after controlling for age and comorbidity. Based on lower costs and better outcomes, LC seems to be the treatment of choice for acute and chronic cholecystitis.     

Zeus robot-assisted laparoscopic cholecystectomy in comparison with conventional laparoscopic cholecystectomy

BACKGROUND: The robotic surgical system overcomes many technological obstacles of conventional laparoscopic surgery, and possesses enormous clinical applied potential. The aim of this study was to compare the efficacy of Zeus robot-assisted laparoscopic cholecystectomy with conventional laparoscopic cholecystectomy. METHODS: Forty patients undergoing elective cholecystectomy were randomly divided into two groups. Patients in group A (n=20) underwent Zeus robot-assisted laparoscopic cholecystectomy, and patients in group B (n=20) received conventional laparoscopic cholecystectomy. The parameters on operative field, operative time, the number of actions, the rate of operative errors and minimal trauma were evaluated and compared between the two groups. RESULTS: The number of cleating camera (1.1±1.0 times) and the time of adjusting the operative field (2.2±0.7 minutes) in group A were significantly less than those (4.5±1.5 times) and (7.5±1.2 minutes) in group B. The number of dissection actions (337±86 times) and the rate of operative errors (10%) in group A were less than those (389±94 times), (25%) in group B. The total operation time (104.9±20.5 minutes) and setup time (29.5±9.8 minutes) in group A were significandy longer than those (78.6±17.1 minutes), (12.6±2.5 minutes) in group B. Blood loss and postoperative hospitalization were similar. No postoperative complications occurred in both groups, and open cholecystectomy was performed in each group. CONCLUSIONS: Zeus robot-assisted cholecystectomy inherits the benefits of minimally invasive surgery. The Zeus robotic surgical system is better than conventional laparoscopic technique in controlling the operative field and can be manipulated precisely and stablely though it requires more operative time.