医保患者日间腹腔镜胆囊切除术的费用分析

目的探讨医疗保险患者日间腹腔镜胆囊切除术的费用,降低患者医疗费用。方法在医疗保险患者中选择了36例日间腹腔镜胆囊切除术患者,32例常规腹腔镜胆囊切除术患者进行评价分析。结果日间腹腔镜胆囊切除术平均住院费用为5341.207±672.5696元,腹腔镜胆囊切除术平均住院费用为7308.413±533.6341元,两组比较差异显著（P〈0.01）,可降低医疗费用。两组手术全部成功,所有患者均未出现术后出血、感染等并发症。出院后腹胀ALC组2例,LC组3例。离院后发热ALC组3例,LC组2例。术后24小时后伤口疼痛者ALC组6例,LC组8例。以上均未予特殊处理自行缓解。结论日间腹腔镜胆囊切除术在临床中的应用,使患者降低费用的同时,保证医疗质量,又尽早康复,成效显著。     

经脐单孔腹腔镜胆囊切除术48例报告

目的探讨经脐单切口腹腔镜胆囊切除术的可行性及安全性.方法回顾分析48例胆囊结石及胆囊息肉样病变患者行经脐单切口腹腔镜胆囊切除术的临床资料.结果手术时间30～85 min,平均45 min;术中出血平均22 mL,无并发症发生;术后随访1～3个月,患者均无腹痛、发热及黄疸,脐部无明显瘢痕.结论经脐单切口腹腔镜胆囊切除术治疗胆囊良性疾病安全有效,且更具微创性,美容效果更佳,有待于推广.     

Two cases of acute cholecystitis in which percutaneous transhepatic gallbladder aspiration (PTGBA) was useful

We report 2 patients with acute cholecystitis for which percutaneous transhepatic gallbladder aspiration (PTGBA) was useful. In Case 1, the patient was a 75-year-old woman who experienced a sudden onset of back pain and upper abdominal pain at night. Abdominal ultrasound (US) showed enlargement of the gallbladder with thickening of the wall, a sonolucent layer, and a stone in the neck of the gallbladder, which led to a diagnosis of acute cholecystitis. Magnetic resonance imaging (MRI) demonstrated thickening of the gallbladder wall and 2 areas of low-intensity signal. The pain and fever persisted, for which we performed PTGBA, aspirating about 113 ml of infected bile. Subsequently, the pain and fever subsided, and abdominal US revealed a reduction in the enlargement of the gallbladder with the persistence of thickening of the wall. On the eighth day after PTGBA, open abdominal cholecystectomy was performed. In Case 2, the patient was a 56-year-old woman who had right hypochondriac pain after supper. The pain gradually increased in severity. Abdominal US showed enlargement of the gallbladder with a thickened wall, a sonolucent layer, and a gallstone in the neck of the gallbladder, which led to a diagnosis of acute cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) showed enlargement of the gallbladder with no abnormalities in the common bile duct. After admission to hospital, the pain and fever persisted, for which we performed PTGBA, aspirating about 50 ml of infected bile. Subsequently, the pain and fever vanished. Abdominal US revealed a reduction in the enlargement of the gallbladder with the persistence of thickening of the wall. On the seventh day after PTGBA, laparoscopic cholecystectomy was performed. PTGBA seems useful for early alleviation of the symptoms of acute cholecystitis because of low invasiveness and ease of performance.     

胆囊癌37例临床分析

目的:探讨胆囊癌的临床特点。方法:对我院及上海东方肝胆外科医院收治的37例胆囊癌进行临床分析。结果:胆囊癌多见于老年人,女性多于男性,并存胆囊结石发生率81.1%。结论:B超、CT是常用的诊断方法,早期病例B超诊断率较高,晚期病例CT诊断率高于B超,手术方式及治疗效果取决于胆囊癌的分期及分级。     

Mirizzi综合征的临床诊治分析

目的:探讨Mirizzi综合征的临床特点、影像学特征、诊断及治疗方法。方法:对13例Mirizzi综合征患者的临床资料进行回顾性分析。结果:69.2%(9/13)的患者其临床表现为右上腹疼痛伴有寒战发热、有黄疸病史。76.9%(10/13)的患者术前B超提示胆囊管或胆囊颈部存在结石嵌顿,其中6例行磁共振胆胰管造影(MRCP),提示胆囊结石、胆总管上段梗阻伴肝内胆管扩张。采用Csendes分型:Ⅰ型2例,行保留胆囊颈部的胆囊大部切除术;Ⅱ型4例,行胆囊大部切除术,瘘口直接缝合修补、T管引流;2例Ⅲ型患者,行胆囊部分切除术,残留的胆囊壁修补瘘口、T管引流;4例Ⅲ型患者和1例Ⅳ型患者,行胆囊大部切除术后,作胆肠Roux-en-Y吻合。结论:Mirizzi综合征患者的临床特点为右上腹疼痛多伴有寒战发热、有黄疸病史。术前B超提示胆囊管或胆囊颈部存在结石嵌顿、肝内外胆管扩张、胆总管内无明显结石的患者,应加行MRCP以提高术前诊断率。目前手术仍是确诊的主要手段,术中应根据病理分型采取相应的手术方式。     

急诊腹腔镜胆囊切除术中复杂情况处理的探讨

目的:探究分析进行急诊腹腔镜胆囊切除术过程中出现复杂情况的处理手段。方法:选择行腹腔镜胆囊切除术患者共36例,以回顾性的方法对患者的临床资料进行分析。结果:所有患者平均手术时间为50 min;术中平均出血量为30 ml;患者引流管留置时间在(1~3)d之间,引流量为(30~300)ml,平均引流量为100 ml;所有患者没有出现中转开腹手术以及死亡的情况;1例患者出现术后发热,对症治疗后痊愈。结论:在急诊腹腔镜胆囊切除术过程中有可能会出现较为复杂的情况,这个时候要求术者对于胆道系统解剖要有全面的认识以及熟悉的手术操作技巧,这个是面对此类问题的最好保障。     

合并胆囊结石的肝硬化门脉高压症的治疗

目的探讨合并胆囊结石的门脉高压症合理的治疗方法。方法分析总结我院2002年-2009年收治的34例合井胆囊结石的门脉高压症患者的临床资料。结果5例行断流术,22例一期联合断流及胆囊切除术,7例断流术后2期胆囊切除。34倒中1例死亡,有7例发生9种近期并发症,经治疗痊愈。结论合并胆囊结石的肝硬化门脉高压症一期化断流联合胆囊切除手术安全有效。     

ERCP对胆囊切除术后综合征患者的诊治价值

目的：了解内镜下逆行胰胆管造影术(ERCP)对胆囊切除术后综合征患者的诊治价值。方法：回顾分析90例胆囊切除术后出现腹痛、黄疸或发热症状的患者,接受ERCP检查和／或EPT治疗,比较分析与B超、CT、MRI等影像学检查与ERCP诊断的准确性及ERCP胆囊切除术后患者治疗的结果。结果：ERCP检查对此病诊断的准确性明显高于B超、CT、MRI等影像学检查,而且ERCP对胆总管残余结石或复发结石、胆总管下段炎性狭窄、胆管梗阻等治疗效果良好。结论：ERCP不仅可明显提高对胆囊切除术后综合征患者诊断的准确率,而且可作为治疗此病的一种重要手段。     

胆囊切除术后胆道型Oddi括约肌功能障碍治疗经验并文献复习

目的 总结Oddi括约肌功能障碍(SOD)的临床特点、病因及诊治方法.方法 报告1例胆囊切除术后胆道型SOD,检索并复习1990年至今的国内相关文献.分析SOD的临床特点、病因及诊治方法.结果 患者为女性,胆囊切除术后10余年出现胆样疼痛,曾行肝酶检查提示轻度升高,而血淀粉酶及脂肪酶正常,肝胆胰脾MRI及磁共振胰胆管造影提示无括约肌狭窄、胆道或胰管的狭窄及扩张,诊断为运动功能紊乱型胆道型SOD,口服匹维溴铵片及胆舒胶囊后症状缓解.结论 SOD多发生于胆囊切除术后,女性患者居多,建议对高度怀疑SOD的患者行内镜逆行胰胆管造影检查,检查发现有乳头狭窄者可直接行内镜下十二指肠乳头括约肌切开,但对于仅有疼痛而无其他特殊表现患者建议内科保守治疗.     

ERCP联合腹腔镜治疗胆囊结石伴胆总管结石32例临床分析

目的探讨逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）对胆囊结石伴胆总管结石治疗的临床应用。方法 32例胆囊结石伴胆总管结石病变患者,先用ERCP、乳头切开术（EST）取石;或ERCP和鼻胆管引流（ENBD）及柱状气囊扩张术（EPBD）治疗,术后5-14天,患者无发热、腹痛,血淀粉酶正常,再按常规四孔法施行LC。结果 31例（96.9%）成功完成ERCP术。25例行EST术,6例用EPBD,31例置ENBD,2例仅造影诊断。31例胆总管结石全部取尽。31例完成LC术,1例开腹手术。3例（9.3%）ERCP术后急性轻型胰腺炎,无LC和EST相关并发症。结论 ERCP联合腹腔镜对胆囊结石伴胆管病变的治疗,符合外科微创诊治理念,是外科微创术式的可靠选择。