复杂性腹腔镜胆囊切除术手术安全性探讨

目的:探讨复杂性腹腔镜胆囊切除术确保安全的方法。方法:回顾复杂性腹腔镜胆囊切除术178例,分析Calot三角解剖变异、胆囊颈部结石嵌顿、胆囊管结石、腹腔粘连、胆囊萎缩等复杂因素。结果:8例中转开腹(4.5%),170例成功完成腹腔镜手术,术后无严重并发症发生。结论:重视术中各种复杂因素,熟练掌握手术操作技能及对策,复杂性腹腔镜胆囊切除术仍然安全可行。     

慢性萎缩性胆囊炎98例腹腔镜手术探讨

目的探讨腹腔镜下慢性结石性萎缩性胆囊炎胆囊切除的手术方法和预防胆管损伤并发症的发生。方法对2005年6月至2008年12月98例慢性萎缩性胆囊炎行腹腔镜胆囊切除术的临床资料进行回顾性分析。结果腹腔镜下胆囊切除75例,胆囊大部切除术17例,中转开腹6例;常规肝下放置腹腔引流管,术后1～3天拔管;恢复良好;无其他并发症发生及死亡病例;术后胆漏1例,经腹腔引流治愈。结论萎缩性胆囊炎腹腔镜手术治疗是安全的,但应属于复杂手术。熟练术中操作技巧,仔细分离胆囊周围粘连,清晰解剖胆囊三角,辨认壶腹部与胆囊管的交界,合理处理胆囊管,严格掌握腹腔镜胆囊切除术、胆囊大部切除术的指征,正确掌握中转开腹时机,预防性放置负压引流管是成功完成手术的关键。掌握手术适应证、细致的操作及熟练的腹腔镜技术对萎缩性胆囊炎的治疗是可行的、有效的。     

腹腔镜下萎缩性胆囊炎切除方法的探讨

目的：总结腹腔镜下慢性结石性萎缩性胆囊炎胆囊切除的手术方法和经验。方法：总结2003年1月～2007年5月36例慢性结石性萎缩性胆囊炎患者行腹腔镜胆囊切除术中分离胆囊周围粘连、解剖Calot三角、处理胆囊管及胆囊动脉、切除胆囊的方法。结果：腹腔镜下胆囊切除30例,中转开腹6例。4例胆囊三角区广泛致密粘连,无法分离,行开腹胆囊大部切除术。腹腔镜术后胆漏2例,经腹腔引流治愈。结论：萎缩性胆囊炎腹腔镜手术治疗是安全的。仔细分离胆囊周围粘连,辨认壶腹部与胆囊管的交界,准确解剖Calot三角,合理处理胆囊管,正确掌握中转开腹时机是成功完成手术的关键。     

腹腔镜治疗慢性萎缩性结石性胆囊炎41例报告

目的探讨腹腔镜胆囊切除和次全切除术在治疗慢性萎缩性结石性胆囊炎中的可行性与手术技巧。方法2006年5月～2012年8月,腹腔镜治疗慢性萎缩性胆囊炎合并胆囊结石41例,其中26例行胆囊切除术（1aparoscopic cholecystectomy,LC）,15例行胆囊次全切除术（1aparoscopic subtotal cholecystectomy,LSC）。结果 LC 26例中4例中转开腹（2例胆总管损伤,2例术中出血）,手术时间（137．5±11．0）min,出血（177．7±36．5）ml,术后胆漏1例,继发性胆总管结石2例;LSC15例均成功,手术时间（99．9±10．1）min,出血（62．0±9．1）ml,术后胆漏1例,继发性胆总管结石1例。随访6—32个月,平均12．3月,均无明显消化道不良表现。结论腹腔镜治疗慢性萎缩性结石性胆囊炎是安全有效的。除了娴熟的手术技巧和精细、耐心的手术操作,根据患者实际情况,合理选择腹腔镜胆囊切除或次全切术式是手术成功的关键。     

急性结石性胆囊炎腹腔镜手术时机探讨

目的探讨急性结石性胆囊炎行腹腔镜胆囊切除术(lparoscopic cholecystectomy,LC)的手术时机。方法回顾性分析我院2008年1月～2010年6月完成的397例LC患者的临床资料,按发病至手术时间间隔分为三组:A组165例,间隔时间<72 h;B组101例,间隔时间72 h～2周;C组131例,间隔时间>2周。比较三组平均手术时间、术中出血、中转开腹率、住院时间及住院费用。结果 397例手术中,中转开腹9例(2.3%),余均顺利完成LC,无死亡病例,术后病理均证实为急性结石性胆囊炎或慢性结石性胆囊炎急性发作。A组发生胆瘘3例,B组5例,均经抗感染等内科治疗并充分引流后治愈。无肠管损伤、腹腔感染等并发症。三组比较:A组手术时间短于B、C组(P<0.05),而B、C组间无统计学差异(P>0.05);B组出血量最大,C组最少,三组间有显著性差异(P<0.05);C组住院时间长于A、B组(P<0.05),A、B组间无统计学差异(P>0.05);B组并发症发生率高于A、C组(P<0.05),A、C组间无统计学差异;C组住院费用高于A、B组;三组间中转开腹率无统计学差异(P>0.05)。结论对于急性结石性胆囊炎,无论发病时间是否在72 h内,尽早行LC是安全可行的。     

急性胆囊炎腹腔镜手术146例报告

目的：探讨急性胆囊炎行腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）的可行性。方法：回顾性分析2000年2月～2005年2月146例急性胆囊炎腹腔镜手术切除的临床资料。结果：LC 130例，其中1例出现胆漏，1例腹腔残余结石，2例剑突下切13感染。中转开腹手术16例：结石嵌顿于胆囊管近端5例，胆囊及三角区炎症瘢痕粘连3例，胆囊动脉损伤3例，结石散落腹腔2例，胆囊与周围组织粘连严重2例，术中诊断胆囊癌1例。无死亡和肝外胆道损伤等并发症发生。结论：随着腹腔镜技术的日益成熟和手术经验积累，急性胆囊炎行LC是安全可行的。     

腹腔镜手术治疗早期急性胆囊炎与慢性胆囊炎的疗效比较

目的:探讨腹腔镜胆囊切除术(LC)治疗早期急性胆囊炎的手术疗效。方法:回顾性分析我院2004年1月至2006年2月间收治的51例行腹腔镜手术的早期急性胆囊炎病例,231例慢性胆囊炎病例,比较两组间各项临床资料。结果:早期急性胆囊炎组和慢性胆囊炎手术组的中转开腹率分别是1.96%和1.73%,无显著性差异,两组均未出现严重并发症。结论:急性胆囊炎自发病起48h内早期施行腹腔镜,中转开腹率极低,手术安全可靠,可将腹腔镜手术治疗作为早期急性胆囊炎的常规治疗手段。     

萎缩性胆囊炎106例腹腔镜手术治疗

目的总结腹腔镜下萎缩性胆囊炎手术治疗的技巧及经验。方法 2000年2月～2010年1月对106例萎缩性胆囊炎行三孔法腹腔镜胆囊切除术。结果腹腔镜胆囊切除88例,胆囊大部切除12例,6例行中转开腹胆囊切除（3例因Calot三角致密粘连、解剖不清,胆囊管无法分离,中转开腹胆囊切除;2例胆囊与周围组织致密粘连,分离后见十二指肠内瘘形成,修补;1例胆囊颈部结石压迫右肝管造成右肝管穿孔,行胆管整形T管引流术,T管12个月后拔除）。术后胆漏5例,保持腹腔引流通畅,术后7～10 d拔除引流管。106例随访3～24个月：1例中转开腹行胆管整形T管引流术,术后12个月T管造影显示胆管黏膜连续性正常,顺利拔除;4例出现轻度腹泻,术后3个月内症状逐渐消失;2例术后轻度腹胀,对症治疗后好转;均无胆管狭窄、肠梗阻等术后并发症。结论在细致操作及熟练的腹腔镜技术前提下,萎缩性胆囊炎腹腔镜手术是安全、可行的,但Calot三角冰冻样粘连、腹腔致密粘连或内瘘形成等复杂情况是中转开腹手术的指征。     

急性胆囊炎腹腔镜手术治疗体会

目的 探讨基层医院急性胆囊炎腹腔镜手术的安全性. 方法 回顾分析328例急性胆囊炎行LC手术临床资料. 结果 本组病例中转开腹11例,术后胆汁漏1例,行再次手术治愈. 结论 在基层医院选择好手术时机治疗急性胆囊炎安全、可靠.提高手术技巧,有利于降低中转开腹率和减少并发症.     

腹腔镜胆囊切除术治疗急性胆囊炎手术时机探讨

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.方法 前瞻性纳入2016-06—2020-12于镇江市中医院普外科行LC治疗的88例急性胆囊炎患者.根据手术时机分为早期组(72 h内)和延期组(72 h以后).比较2组患者的基线资料、术中情况、术后临床指标,统计住院费用.结果 共纳入88例患者,每组44例....     

Laparoscopic management of acute cholecystitis

Background: Laparoscopic cholecystectomy for acute cholecystitis is considered feasible and safe, but it is associated with a higher rate of conversion to laparotomy than elective cholecystectomy because of technical reasons and anatomical changes related to the inflammatory process. The value of several factors that might influence its successful completion has not been studied completely yet, including the role of residents in operating such cases under attending-surgeon surveillance. Methods: In a retrospective nonrandomized study, the medical charts of 182 patients that were operated for acute cholecystitis (94 of whom via the laparoscopic approach) were studied. The study was also conducted to study the effect of residents as operators. Results: Male sex, duration of right upper abdominal pain, and the severity of the inflammatory process have all been significantly and independently correlated with increased conversion rate to laparotomy. Operation time was not longer than that of the open approach, and hospital stay and complication rate were lower. Operations performed by residents were associated with twofold conversion rate to laparotomy, without increased complication rate (p < 0.012). Conclusions: Laparoscopic management of acute cholecystitis is feasible and safe. Considering the factors discussed above, lowering the threshold for conversion is necessary in selected cases to maintain low morbidity rate. Integrating laparoscopic cholecystectomy for acute cholecystitis into surgical residency should be studied. Received 5 January 1996/Accepted 22 April 1996     

Laparoscopic cholecystectomy: a safe approach for management of acute cholecystitis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy (LC) is increasingly being used as an appropriate early treatment in patients with cholecystitis. This study evaluated the safety, effectiveness, and complications of LC in all cases of acute cholecystitis. METHODS: A retrospective study involved the patients who underwent LC for acute cholecystitis within 72 hours of admission. The preoperative diagnosis was based on clinical, laboratory, and echographic examinations, while the final diagnosis was confirmed by histopathological examination of the excised gallbladder. RESULTS: We identified 184 patients with acute cholecystitis. Intraoperative cholangiography (IOC) was not performed. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 62 patients (33.7%), and postoperative ERCP in 13 patients (7.1%). Conversion to open cholecystectomy was necessary in 19 patients (10.3%); 16 patients for severe inflammation and adhesions and 3 patients because of uncontrolled bleeding. The mean operative time was 68 minutes. No deaths occurred. The overall complication rate was 6% with 3 postoperative bile leakages and 2 nonbilious subhepatic collections. The mean postoperative hospital stay was 2.8 days. CONCLUSIONS: LC is a safe, effective procedure for the early management of patients with acute cholecystitis. LC can be safely performed without routine IOC when ERCP is performed preoperatively on the basis of specific indications. Meticulous dissection and good exposure of Calot's triangle may prevent bile duct injuries.     

腹腔镜胆囊切除术在急性胆囊炎中的应用

目的评价急性胆囊炎中应用腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的方法和疗效. 方法回顾分析1998年8月～2003年8月LC治疗急性胆囊炎201例. 结果本组均于入院24 h内行LC.完成LC 192例(95.52%),中转开腹9例.手术时间40～150 min,平均85 min.随访2～12个月,无并发症. 结论急性胆囊炎中应用LC难度大、变异多,但只要严格掌握手术适应证和手术技巧,在基层医院开展LC是可行的.     

Laparoscopic cholecystectomy for acute cholecystitis

The application of laparoscopic cholecystectomy (Lap. C) for acute cholecystitis (AC) remains controversial from the viewpoint of its higher rate of morbidity, and conversion to open surgery, in spite of the worldwide acceptance of Lap. C as the gold standard for the treatment of patients with symptomatic gallbladder diseases. The conversion rate has been reported to decrease with experience. Local and overall complication rates were shown to correlate with the time delay between the onset of acute symptoms and the operation. Although percutaneous gallbladder drainage (PGBD) has been reported to be a safe and effective procedure for the treatment of AC, it should be limited to high-risk groups such as elderly or critically ill patients. Early cholecystectomy within 4 days from the onset is strongly recommended to minimize surgical complications and to increase the chance of a successful laparoscopic approach. Received: April 29, 2002 / Accepted: May 30, 2002 Offprint requests to: S. Kitano     

Laparoscopic cholecystectomy for acute cholecystitis

Summary Because laparoscopic cholecystectomy reduces hospitalization time and postoperative disability, it is being offered to an increasing number of patients with symptomatic gallstones. Nevertheless, acute cholecystitis is still considered by many surgeons to be a relative contraindication. Our standard approach has been to perform laparoscopy on all patients considered candidates for cholecystectomy. From June 1990 to October 1991, the authors personally performed laparoscopic cholecystectomy on 110 patients, 29 (26%) of whom had pathologically confirmed acute cholecystitis. Of these, nine had evidence of gangrene, perforation, or abscess formation. It was necessary to convert to open cholecystectomy in four (14%) patients. In each, inflammation or dense adhesions precluded the performance of a safe operation. The hepatorenal space was drained in 12 (41%) and cystic dust cholangiograms were performed selectively. The mean operating time was 108 min. There were no intraoperative complications. One patient developed a prolonged postoperative paralytic ileus and two patients were noted to have postoperative common duct stones. There were no deaths. The average postoperative stay for laparoscopic cholecystectomy was 2.6 days. We conclude that the advantages of laparoscopic cholecystectomy can be safely and effectively extended to the majority of patients with acute cholecystitis.     

Laparoscopic cholecystectomy for acute cholecystitis

From October 1991 to March 1994, 35 patients (20 men and 15 women) with acute cholecystitis (AC) underwent laparoscopic cholecystectomy (LC). They ranged in age from 17 to 82 years (mean, 51.7 years). Nine of the 35 patients (25.7%) had either percutaneous transhepatic gallbladder drainage (PTGBD) or percutaneous transhepatic gallbladder aspiration (PTGBA) performed preoperatively. The mean operative time was 183.7 min. Four of the 35 patients (11.4%) required conversion to open laparotomy. The mean postoperative hospital stay was 11.2 days and postoperative morbidity rate was 2.9%. There were no major complications and no deaths. In this retrospective study, we divided the patients into three groups according to the surgical timing of LC in relation to onset. Two of the three groups had LC performed more than 7 days after onset; these groups were termed, collectively, the delayed LC group. The group that had LC performed within 7 days of onset we termed the early LC group. The early LC group had a shorter operative time, less blood loss, and a shorter postoperative hospital stay than the delayed LC group, but the differences were not significant. Nevertheless, we suggest that early LC for AC should be employed for patients who are in a stable condition and who have no preoperative associated medical problems. In the delayed LC group, there were no significant differences in findings between patients who received or did not receive either PTGBD or PTGBA. PTGBD and PTGBA are useful procedures for the relief of acute severe symptoms in patients whose condition is refractory to treatments such as i.v. antibiotic infusion and no oral feeding. We conclude that a laparoscopic procedure for patients with AC, when performed by experienced surgeons, is safe, technically feasible, and useful.     

Laparoscopic subtotal cholecystectomy for severe cholecystitis

Background: In severe cholecystitis, laparoscopic cholecystectomy can be technically difficult, and is associated with an increased rate of procedure conversions and common bile duct lesions. Methods: We investigated the safety and complications of laparoscopic subtotal cholecystectomy for severe cholecystitis in a medium- to long-term follow-up evaluation. Laparoscopic cholecystectomy was performed in 345 patients during a period of 64 months. In 46 of the patients (13.3%), a subtotal cholecystectomy was performed. The results were compared with data on laparoscopic cholecystectomy from 16,130 patients in 84 surgical institutes in Switzerland, collected prospectively by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS). Results: The median operating time was 93 min (range, 50–140) min. The overall rate of procedure conversions in acute cholecystitis was lowered significantly from 23.2% (SALTS) to 9.7%. There was no bile duct lesion, as compared with the rate of 0.8% in the SALTS data. In follow-up evaluations, fluid collections in 16 patients (35%) and residual gallstones in 6 patients (13%) were of no clinical relevance. Conclusions: Laparoscopic subtotal cholecystectomy for acute cholecystitis offers a simple and safe solution that prevents bile duct injuries and decreases the rate of conversion in anatomically difficult situations.     

吸引器推吸法在复杂的急性胆囊炎腹腔镜胆囊切除术中的应用

目的探讨腹腔镜吸引器在复杂性胆囊炎的胆囊切除术中的应用。方法2004年1月-2005年3月对本组45例需要急症手术的急性胆囊炎采用腹腔镜吸引器推吸法进行胆囊切除作回顾分析。结果43例病变严重的急性胆囊炎全部在腹腔镜下完成胆囊切除术,2例中转开腹,术中无副损伤、术后恢复快,无并发症发生,患者痊愈出院。结论吸引器推吸法可以推出重要管道结构,同时吸去术野积血,清楚显露术野,对较好的处理病变严重的急性胆囊炎是一种有效的方法,值得进一步推广和应有。     

结石性萎缩性胆囊炎的腹腔镜手术治疗

目的 总结腹腔镜下结石性萎缩性胆囊炎处理的经验。方法 回顾分析1997年-2000年，56例结石性萎缩性胆囊炎行腹腔镜胆囊切除术。结果 腹腔镜下胆囊切除52例，其中顺行切除39例，逆行切除13例；中转开腹行胆囊切除4例，其中3例胆总管切开探查T管引流。腹腔置引流管8例。56例均治愈，2例出现胆漏，经置管保守治愈。结论 解剖清晰、认准变形的壶腹与胆囊管交界部位、严格掌握腹腔镜胆囊切除术的指征和开腹时机、预防性放置引流管是结石性萎缩性胆囊炎腹腔镜胆囊切除成功的关键。     

腹腔镜胆囊切除术治疗急性结石性胆囊炎临床体会

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗急性结石性胆囊炎的手术及操作要点。方法：回顾分析我院2000年3月-2009年8月行LC治疗的1260例急性胆囊炎并胆囊结石病例。结果：顺利完成LC1220例,中转开腹胆囊切除术40例,无术中大出血、肝外胆管损伤而中转开腹的病例。无术后胆汁漏、腹腔内出血等严重并发症发生。所有患者随访3月～1年,无胆管狭窄等相关并发症发生。结论：LC治疗急性胆囊炎安全可行,术者必须充分了解LC操作要点和熟练掌握操作技术。